Efficacy and safety of intraoperative radiotherapy in rectal cancer: A systematic review and meta-analysis

Liu, Bin; Ge, Long; Wang, Jing; Chen, Yaqiong; Ma, Shi-Xun; Ma, Peilan; Zhang, Yunqiang; Yang, Kehu; Cai, Hui

doi:10.4251/wjgo.v13.i1.69

Cited by 10 publications

(6 citation statements)

References 49 publications

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“…We conducted literature studies related to robotic surgery in the disciplines of general surgery, thoracic surgery, obstetrics and gynecology, and urology based on our research literature database, and published 16 systematic evaluation and meta‐analyses, as shown in Table 1 (Gou, Bai, et al, 2017; Gou, Ma, et al, 2017; Han et al, 2018; Han, Cheng, et al, 2020; Han, Tian, et al, 2020; Han, Yan, Cai, et al, 2020; Han, Yan, Jing, et al, 2020; Hu et al, 2020; Li et al, 2018; Liu et al, 2021; Liu, Wakabayashi, et al, 2019; Ma et al, 2019; Ma et al, 2020; Niu et al, 2019; Wang, Yan, et al, 2018; Wang, Yao, et al, 2018; Yan et al, 2019; Zhang et al, 2021; Zhou et al, 2015). These articles provide a high‐quality evidence‐based foundation for the application of robotic surgery.…”

Section: Resultsmentioning

confidence: 99%

Establishment and implementation of a clinical application and research database for surgical robots in China

Ma,

Li,

et al. 2023

WIREs Data Min & Knowl

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Robots are widely used in surgeries worldwide. To improve robotic surgical treatments, we established a database of clinical applications and research on surgical robots. Robotics‐related literature included in the China national knowledge infrastructure (CNKI), Wanfang, Vipshop, Chinese science citation database (CSCD), Web of Science, EMBASE, PubMed, and Cochrane databases up to September 2022 was searched and entered into the database. Information on all patients who had undergone robotic surgery at our hospital since 2016 was also included. Literature and case information was classified and evaluated according to standard guidelines and statements. The Gansu Provincial Hospital was the first to use evidence‐based medical research methods to successfully establish a database of clinical applications and research on surgical robots. This database comprised literature search, upload, quality evaluation, risk of bias assessment, case information entry, and access functions. Based on the database, we conducted related studies in general surgery, gynecology, urology, thoracic surgery, and cardiovascular surgery, and published 16 meta‐analyses and 15 clinical studies. Establishing this database removes language, retrieval, and evaluation barriers in clinicians' use of clinical evidence and lays the foundation for the efficient and accurate use of clinical data for future research. Further, it facilitates evidence‐based evaluation of the effectiveness of robotic therapy, which may guide future medical practice. This typical case of interdisciplinary research aims to build a platform to disseminate knowledge and technology in robotic surgery.This article is categorized under: Technologies > Computer Architectures for Data Mining Application Areas > Data Mining Software Tools Application Areas > Education and Learning

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Section: Resultsmentioning

confidence: 99%

Establishment and implementation of a clinical application and research database for surgical robots in China

Ma,

Li,

et al. 2023

WIREs Data Min & Knowl

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“…The IMPulse trial, a phase I dose escalation study of FLASH therapy in patients with cutaneous metastases of melanoma and the LANCE trial, a Phase II study for Patients With Localized Squamous Cell Carcinoma or Basal Cell Carcinoma. Low energy electron should be also tested in IORT, a radiotherapy technique sometimes used for selected cases of patients with recurrent soft tissue sarcoma, rectal and cervical cancer ( 81 – 83 ). It has been also employed in adjuvant therapy in breast and pancreatic cancer surgery alone or combined with external-beam radiation therapy ( 84 , 85 ).…”

Section: Discussionmentioning

confidence: 99%

Electron FLASH radiotherapy in vivo studies. A systematic review

Giannini,

Gadducci,

Fuentes

et al. 2024

Front. Oncol.

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FLASH-radiotherapy delivers a radiation beam a thousand times faster compared to conventional radiotherapy, reducing radiation damage in healthy tissues with an equivalent tumor response. Although not completely understood, this radiobiological phenomenon has been proved in several animal models with a spectrum of all kinds of particles currently used in contemporary radiotherapy, especially electrons. However, all the research teams have performed FLASH preclinical studies using industrial linear accelerator or LINAC commonly employed in conventional radiotherapy and modified for the delivery of ultra-high-dose-rate (UHDRs). Unfortunately, the delivering and measuring of UHDR beams have been proved not to be completely reliable with such devices. Concerns arise regarding the accuracy of beam monitoring and dosimetry systems. Additionally, this LINAC totally lacks an integrated and dedicated Treatment Planning System (TPS) able to evaluate the internal dose distribution in the case of in vivo experiments. Finally, these devices cannot modify dose-time parameters of the beam relevant to the flash effect, such as average dose rate; dose per pulse; and instantaneous dose rate. This aspect also precludes the exploration of the quantitative relationship with biological phenomena. The dependence on these parameters need to be further investigated. A promising advancement is represented by a new generation of electron LINAC that has successfully overcome some of these technological challenges. In this review, we aim to provide a comprehensive summary of the existing literature on in vivo experiments using electron FLASH radiotherapy and explore the promising clinical perspectives associated with this technology.

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“…Most of the challenges in the treatment of rectal cancer concern the lowest located and the locally advanced tumors. Several reports have described the availability and effectiveness of IOeRT combined with preoperative chemoradiation for controlling LARC [ 12 ] and promoting improved local control results compared to non-IOeRT strategies based on systematic reviews [ 13 , 14 ]. In particular, the data reported in cT4 patients and isolated recurrences, using IOeRT as a component of local intensification treatments [ 15 , 16 ], are incorporated in the experts’ guidelines as a component of the multimodal treatment that is recommended in clinical practice [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

et al. 2022

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Background Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. Methods Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. Results In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. Conclusions Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.

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Efficacy and safety of intraoperative radiotherapy in rectal cancer: A systematic review and meta-analysis

Cited by 10 publications

References 49 publications

Establishment and implementation of a clinical application and research database for surgical robots in China

Establishment and implementation of a clinical application and research database for surgical robots in China

Electron FLASH radiotherapy in vivo studies. A systematic review

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

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