Intraoperative radiation therapy of hepatic metastases: Technical aspects and report of a pilot study

Dritschilo, Anatoly; Harter, K. William; Thomas, David S.; Nauta, Russell J.; Holt, Richard W.; Lee, T.C.; Rustgi, Sheila D.; Rodgers, James

doi:10.1016/0360-3016(88)90026-0

Cited by 40 publications

(13 citation statements)

References 5 publications

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“…First, IORT is an open procedure with significant invasiveness and procedurerelated comorbidity. Second, administering the radiation dose in the target volume is hampered by the fact that applicator placement is guided either by manual palpation or sonographic monitoring [19,20] . In this situation, neither adequate coverage of the target volume fraction nor exact sparing of adjacent critical tissue such as hepatic reserve capacity, bile duct or intestine can be guaranteed.…”

Section: Introductionmentioning

confidence: 99%

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Image-Guided Interstitial High-Dose-Rate Brachytherapy in Hepatocellular Carcinoma

Mohnike

Wieners

Pech

et al. 2009

Dig Dis

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New interventional options especially for patients with HCC and BCLC scores B and C give rise to disputes about the optimal therapeutic management. CT-guided brachytherapy complements established interventional techniques like RFA and TACE since it may also be used successfully in tumors much greater than 5 cm in diameter. In addition, unlike thermal ablation, the brachytherapy technique may be applied in tumors located nearby risk structures such as liver hilum or gallbladder and it is independent of cooling effects such as through large blood vessels or strong tumor perfusion. Depending on tumor size, geometry and visibility, MRI or CT guidance may be used. 15 Gy minimal target dose can be applied safely in a single or – in case of very large tumors – a sequential approach targeting different tumor portions. Local recurrence rates will be very low, and the rate of complications is moderate despite the fact that most patients present with underlying cirrhosis and related comorbidities. Preliminary data suggest a positive impact on overall survival. Randomized controlled trials are on their way to assess combination schemes with systemic treatments such as sorafenib.

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Section: Introductionmentioning

confidence: 99%

“…The typical doses applied ranged from 15 to 30 Gy with reference to the tumor margin. The brachytherapy technique generally leads to a high dose inhomogeneity in the target volume [14][15][16][17][18] . However, the intraoperative approach has some drawbacks.…”

Section: Introductionmentioning

confidence: 99%

Image-Guided Interstitial High-Dose-Rate Brachytherapy in Hepatocellular Carcinoma

Mohnike

Wieners

Pech

et al. 2009

Dig Dis

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“…This technique was developed in the late 1980s in an attempt to combine the technical and dosimetric advantages of brachytherapy with the conceptual and logistic advantages of IOERT [8][9][10][11][12][13][14][15][16]. Although HDR remote after loaders were initially utilized in 1964 and have become common in modern radiation oncology departments, they have been used primarily in the outpatient setting.…”

Section: Experiences In Hdr-iortmentioning

confidence: 99%

Intraoperative radiation therapy

Calvo

Meiriño

Orecchia

2006

Critical Reviews in Oncology/Hematology

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“…Prinzipiell befürchten wir für dieses Vorgehen erhöhte Fehlertoleranzen. Dritschilo et al [8] beschreiben Ergebnisse einer Studie an elf Patienten unter Nutzung einer 192 Ir-Brachytherapie zur Einzeitbestrahlung mit angestrebten minimalen 20 Gy. Die Anzahl behandelter Lebermetastasen variierte zwischen zwei und elf mit Durchmessern zwischen 3 und 9 cm (Median: 6 cm).…”

Section: Diskussionunclassified

“…Die angegebenen Dosen variieren zwischen minimal 15 und 30 Gy mit erheblichen Dosisinhomogenitäten innerhalb des Tumorvolumens [8,29]. Nachteile des intraoperativen Ansatzes sind die Notwendigkeit der Laparotomie mit einer erheblichen Komorbidität und eine unzulängliche Dosimetrie nach palpatorischer oder sonographisch geführter Platzierung der Katheter [8].…”

Section: Introductionunclassified