High-Dose-Rate Intraoperative Radiation Therapy for Recurrent Head-and-Neck Cancer

Perry, David J.; Chan, Kelvin K.; Wolden, Suzanne L.; Zeléfsky, Michael J.; Chiu, Johnny; Cohen, Gilad; Zaider, Marco; Kraus, Dennis H.; Shah, Jatin P.; Lee, Nancy

doi:10.1016/j.ijrobp.2009.03.025

Cited by 31 publications

(26 citation statements)

References 28 publications

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“…Adjuvant EBRT at recurrence was given to 15% of the patients with a median dose of 50 Gy. With 10–20 Gy of HDR IORT, 2-year LC and 2-year OS were 56 and 55%, respectively (6). An earlier series by Nag et al reported less favorable outcomes as compared to other listed studies.…”

Section: Role Of Iort In Head and Neck Tumorsmentioning

confidence: 99%

“…Although IORT is mainly used in recurrent patients, few studies reported on its use in the primary setting. Two forms of IORT have been studied for HNCs: high-dose rate (HDR) brachytherapy (6) and external beam that includes electrons and orthovoltage photons IORT (3, 4). The purpose of this manuscript is to review experience over the past four decades with the use of IORT in patients with primary or recurrent cancer of head and neck.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

et al. 2017

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Every year, almost 62,000 are diagnosed with a head and neck cancer (HNC) and 13,000 will succumb to their disease. In the primary setting, intraoperative radiation therapy (IORT) can be used as a boost in select patients in order to optimize local control. Addition of external beam radiation to limited volumes results in improved disease control over surgery and IORT alone. In the recurrent setting, IORT can improve outcomes from salvage surgery especially in patients previously treated with external beam radiation. The use of IORT remains limited to select institutions with various modalities being currently employed including orthovoltage, electrons, and high-dose rate brachytherapy. Practically, execution of IORT requires a coordinated effort and careful planning by a multidisciplinary team involving the head and neck surgeon, radiation oncologist, and physicist. The current review summarizes common uses, outcomes, toxicities, and technical aspects of IORT in HNC patients.

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Section: Role Of Iort In Head and Neck Tumorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

et al. 2017

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“…Patients selected for IORT mainly consisted of recurrent or persistent cancers, who have been previously irradiated and delivery of sufficient doses of EBRT was not possible at the time of recurrence. Most studies have shown effective local control with acceptable complications [17, 19–22]. Resection status at salvage was the most important factor determining local control [17, 19, 21].…”

Section: Clinical Results With Iortmentioning

confidence: 99%

“…Most studies have shown effective local control with acceptable complications [17, 19–22]. Resection status at salvage was the most important factor determining local control [17, 19, 21]. Microscopically residual tumours did better with IORT [23], gross residual disease however did not [20, 23].…”

Section: Clinical Results With Iortmentioning

confidence: 99%

Intraoperative radiotherapy: review of techniques and results

Pilar¹,

Gupta²,

Laskar³

et al. 2017

ecancer

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Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community.Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise.IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers).This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.

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“…Учитывая, что лишь у 15-30 % пациентов заболевание выявляется на ранней стадии, в то время как от 60 % до 80 % пациентов имеют местнораспространенный процесс, одной из основных проблем лечения рака головы и шеи является предотвращение или ограничение локального рецидива, поскольку улучшение локорегионарного контроля непо-средственно влияет на выживаемость пациентов [7][8][9][10][11].…”

Section: Introductionunclassified