Intraoperative delivery of cell-killing boost radiation – a review of current and future methods

Abstract

Techniques for intraoperative radiation therapy (IORT), the applications of tumor bed radiation immediately after surgery or utilising intracavitary access, have evolved in recent years. They are designed to substitute or complement conventional external beam radiation therapy in selected patients. IORT has become an excellent treatment option because of good long-term therapy outcomes. The combination of IORT with external beam radiation therapy has the potential to improve local control. The purpose of this paper is to present IORT techniques using gamma and electronic sources, as well as more conventional nuclide-based approaches and to evaluate their effectiveness. Common techniques for radiation of tumor cavities are listed and compared. Radionuclide IORT methods are represented by balloon and hybrid multi-catheter devices in combination with appropriate afterloaders. Electron beam therapy dedicated for use as intraoperative radiation system is reviewed and miniature x-ray sources in electronic radiation therapy are presented. These systems could further simplify IORT, because they are easy to use and require no shielding due to their relatively low photon energies. In combination with additional imaging techniques (MRI, US, CT and NucMed) the application of these miniature x-ray sources or catheter-based nuclide therapies could be the future of IORT.

Intraoperative radiotherapy in breast cancer: Alterations to the tumor microenvironment and subsequent biological outcomes (Review)

“…Most patients require a tumor bed boost of 10-16 Gy, with the total treatment duration spanning 3-7 weeks (10). However, in comparison with traditional whole-breast irradiation, intraoperative rT (iorT) involves the delivery of high-dose internal brachytherapy radiation therapy to the postoperative region, including the tumor bed and any remaining lesions (11). compared to eBrT, iorT only requires a few minutes to deliver the necessary radiation dose during surgery, with lower radioactive side effects, reducing the risks of complications such as infection, breast fibrosis, and dermatitis (12).…”

Prognosis comparison between intraoperative radiotherapy and whole-breast external beam radiotherapy for T1–2 stage breast cancer without lymph node metastasis treated with breast-conserving surgery: A case–control study after propensity score matching

“…Intraoperative radiotherapy (IORT) is a form of APBI radiotherapy first used in the 1960s. IORT is a single high-dose radiotherapy treatment for the tumor bed, residual lesions, and lymphatic drainage areas directly observed during surgery; it has the advantages of shortening treatment duration and effectively protecting normal tissues and has been used for low-risk patient groups, especially those with early stage breast cancer without axillary lymph node metastasis (13)(14)(15)(16)(17).…”

Time-varying Acoustic Emission Characterization for Guidewire Coronary Artery Perforation Identification

“…The use of medical interventional devices (MIDs) such as needles, catheters and guidewires is today a common procedure in medicine for performing minimally invasive therapy and diagnosis [1,2]. Generally in all these type of procedures the operator needs to introduce the MID inside the body and place it into a target and/or follow a determined path without damaging important structures or organs.…”