Intraoperative radiotherapy (IORT) for surgically resected brain metastases: outcome analysis of an international cooperative study

Cifarelli, Christopher P.; Brehmer, Stefanie; Vargo, John A.; Hack, Joshua; Kahl, Klaus Henning; Sarria, Gustavo R.; Giordano, Frank A.

doi:10.1007/s11060-019-03309-6

Cited by 44 publications

(46 citation statements)

References 24 publications

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“…To our knowledge, this is the largest published mono institutional series of patients treated with IORT after resection of BM. In contrast to previous publications in this eld [12,13] reporting mainly LC/DC and toxicity data, we report a wider scope of the implementation of IORT in the treatment of patients with brain metastases and its aspects on multidisciplinary care. In the year 2013, we have started treating patients with IORT after neurosurgical BM resection on an individual treatment decision case by case after interdisciplinary discussion and decision in the MTB.…”

Section: Discussioncontrasting

confidence: 72%

“…After publication of the toxicity data of the INTRAGO phase1/2 study [25], we have increased dose stepwise and since 2016, all patients have been irradiated with 20 Gy. Other centers nowadays apply even higher doses [13,25,26]. However, with the reported outcome of our patients we do not see a necessity for further dose escalation currently.…”

Section: Discussionmentioning

confidence: 51%

“…Hereafter the resection cavity was irradiated with 50kV x-rays via an INTRABEAM system (ZEISS MEDITEC AG, Oberkochen) equipped with spherical applicators. The device and procedure was already described before [12,13]. Spherical applicator sizes of this IORT system range from 15 to 50mm in diameter in 5mm increments.…”

Section: Methodsmentioning

confidence: 99%

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Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

Kahl

Balagiannis

Höck

et al. 2021

Preprint

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Purpose External beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50kV x-rays is an alternative way to irradiate the resection cavity focally after BM surgery with the option to shorten the overall treatment time and limit normal tissue irradiation.Methods We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50kV x-ray IORT between 2013 and 2020 at Augsburg University Medical Center.Results We identified 40 patients with 44 resected BM treated with 50kV x-ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3-monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for patients alive of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1-year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1-year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1-year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%.Conclusion IORT with 50kV x-rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 51%

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Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

Kahl

Balagiannis

Höck

et al. 2021

Preprint

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“…have an abscopal effect, i.e., an effect away from the site of irradiation, by influencing the tumour microenvironment or by immunological mechanisms. [14][15][16][17][18][19][20][21][22][23][24][25][26][27]28 Strange as it may seem, such an abscopal effect appears to give long-term protection against deaths from cardiovascular causes and other cancers. The early separation of lines in the K-M curves that starts soon after randomisation also suggests such a 'drug-like' effect, while a separation starting a few years later in the comparison of TARGIT-IORT alone vs. EBRT suggests an effect of avoiding EBRT (Fig.…”

Section: Discussionmentioning

confidence: 99%

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

et al. 2021

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Background The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. Methods In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0–N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. Results Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt. Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17–0.88) P = 0.0091. Conclusion TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect. Trial registration ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).

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“…The application of IORT in the treatment of various types of tumors has significant benefits. Indeed, early breast cancer patients who received IORT during breast-conserving surgery had a better survival period[ 49 ], and in patients with brain metastases, using IORT can deliver auxiliary radiation to the resection cavity with a high LC rate and low incidence of radiation necrosis[ 50 ].…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Wang

et al. 2020

WJGO

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Intraoperative radiotherapy (IORT) for surgically resected brain metastases: outcome analysis of an international cooperative study

Cited by 44 publications

References 24 publications

Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

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

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