Intraoperative Radiotherapy With INTRABEAM: Technical and Dosimetric Considerations

Sethi, Anil; Emami, Bahman; Small, William; Thomas, Tarita O.

doi:10.3389/fonc.2018.00074

Cited by 49 publications

(51 citation statements)

References 30 publications

(26 reference statements)

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“…Tumors larger than 2 cm require removal of a considerable amount of breast tissue [12,13]. In such cases, the size of the remaining cavity requires a larger applicator; furthermore, longer application time is needed to reach an optimal dose, which may in turn prolong the operation time [14]. All of these characteristics contributed to the statistical significance of this factor in our sample.…”

Section: Discussionmentioning

confidence: 88%

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer

et al. 2020

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To study those factors that influence the occurrence of surgical complications and local relapse in patients intervened for breast cancer and receiving intraoperative radiotherapy. Methods: Observational study on patients intervened for breast cancer with conservative surgery and intraoperative radiotherapy with low-voltage X-ray energy source (INTRABEAM), from 2015 to 2017 with 24 months minimum followup. Variables possibly associated to the occurrence of postoperative complications were analyzed with the Student t-test and the Fisher exact test; P < 0.05 considered significant. Subsequently, the construction of multiple multivariate analysis models began, thus building a logistic regression analysis using the IBM SPSS Statistics ver. 23 software. Local relapse was described. Results: The study included 102 patients, mean age of 61.2 years; mean global size of tumor, 12.2 mm. Complications occurred in 29.4%. Fibrosis was the most frequently observed complication, followed by postoperative seroma. Using a 45 mm or larger applicator were significantly associated with the occurrence of complications. Tumor size 2 cm or larger and reintervention showed borderline significant association. Only one case of local relapse was observed. Conclusion: Certain factors may increase the risk of complication after the use of intraoperative radiotherapy. Using external complementary radiotherapy does not seem to increase the rate of complications. Select patients and the involvement of a multidisciplinary team are essential for achieving good results.

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Section: Discussionmentioning

confidence: 88%

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer

et al. 2020

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“…Due to its nature, the portable linear accelerator can be used without major prerequisites into mostly any surgical theater (e.g. that is cleared for C-arm fluoroscopy), as the 50-kV nominal energy delivered plus local shielding is more than sufficient for accomplishing radioprotection regulations [26]. The availability of different applicators allows shaping to most of the surgical beds as needed.…”

Section: Discussionmentioning

confidence: 99%

“…All patients underwent surgery after MRI-based diagnosis establishment and preoperative feasibility assessment. During resection, patients were treated (Intrabeam, Carl Zeiss Meditec AG, Oberkochen, Germany) with either a forward-beaming flat applicator (providing dose uniformity ["flatness"] perpendicular to the beam direction greatest at the prescription depth of 5 mm) or a ball-shaped applicator providing a spherical isotropic dose distribution [21,26], for which the resection borders were approached with a purse-string-like suture. Depending on region, risk structures and previous EBRT irradiation, electronic IORT (eIORT) was delivered with doses between 5 and 20 Gy prescribed to 5 mm (flat applicator) or at the applicator surface (spherical applicators).…”

Section: Patient Selection and Proceduresmentioning

confidence: 99%

Intraoperative radiotherapy with low energy x-rays for primary and recurrent soft-tissue sarcomas

et al. 2020

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Background: Soft tissue sarcomas (STS) treatment remains a therapeutic challenge. Intraoperative radiotherapy (IORT) resembles a safe and efficient for STS treatment. The first data on electronic-IORT (eIORT) using low-energy photons is herein presented. Methods: Thirty-one patients with newly and recurrent STS were retrospectively assessed. EIORT was applied with low-energy photons during surgery. The dose was either prescribed to the applicator surface (spherical applicators) or 5 mm depth (flat applicators). Overall progression-free survival (O-PFS), local progression-free survival (L-PFS), overall survival (OS) and adverse events were evaluated. Results: Median follow-up was 4.88 (1.0-8.95) years. Twenty-five patients (80.6%) had recurrent STS with prior treatment. The resection status was R1 in 25.8% and R2 in 6.5%. The distribution was 51.7% for extremities, 35.5% for abdomen and pelvis, 9.7% for thorax and 3.2% for head and neck tumors. The median O-PFS was 11.0 months, with 42.6% 5-year estimated O-PFS. The only local recurrence in the primary setting occurred after 22 months. Median L-PFS in recurrent STS was 12.5 months, with 65.5% 5-year estimated L-PFS. The 5-year OS estimated rate was 94.7% (3 events after 7 years). No G3 toxicity related to eIORT was observed. Two patients exhibited G2 acute neuropathic pain. Late neuropathic pain was seen in 6 patients being 3 graded as G1 and 3 as G2. No woundrelated toxicity was found. Conclusion: Electronic IORT with low-energy photons is a safe treatment option for STS, yielding similar outcomes as historical series reporting IORT with electrons or HDR brachytherapy.

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“…Carrying out follow-up visits every day during the hospitalization after the surgery and every 1-3 months after discharge (Table 1) Total laryngectomy + use of plate applicator at tumor bed 3) An appropriate irradiation dose is selected by the radiotherapist in order to protect normal surrounding tissues (Fig. 1) [26].…”

Section: Study Proceduresmentioning

confidence: 99%

A prospective, single-arm, phase II clinical trial of intraoperative radiotherapy using a low-energy X-ray source for local advanced Laryngocarcinoma (ILAL): a study protocol

Yang

Zheng

et al. 2020

BMC Cancer

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Background: Laryngocarcinoma (LC), in most cases a squamous cell carcinoma, accounts for 1~5% of the incidence of all tumors. At present, laryngocarcinoma is mainly managed with the integration of surgery and radioand chemo-therapies. The current development trend of treatment is to improve the local control rate of tumor and the quality of life of patients. Intraoperative radiation therapy (IORT) is a radiotherapy that delivers single high dose irradiation at a close range to the tumor bed during the surgical operation process. It has particular radiobiological advantages in protecting normal surrounding tissues by directly applying the irradiation dose to the high-risk tumor bed area. Two forms of IORT, i.e., high dose rate (HDR) brachytherapy and external beam radiotherapy (EBRT, including electron and photono IORT), had been studied before the treatment of head and neck tumors (including laryngocarcinoma). However, no relevant assessment had been carried out on 50KV low-energy X-ray. We are convinced by certain arguments that the application of low-energy X-ray for intraoperative local radiotherapy of laryngocarcinoma can not only achieve the therapeutic effect of IORT but also reduce the incidence of high-energy irradiation related toxic and side effects. The purpose of this study is to observe the safety and short-term efficacy of IORT when used in conjunction with standard of care for the treatment of local advanced laryngocarcinoma (LAL).

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Intraoperative Radiotherapy With INTRABEAM: Technical and Dosimetric Considerations

Cited by 49 publications

References 30 publications

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer

Intraoperative radiotherapy with low energy x-rays for primary and recurrent soft-tissue sarcomas

A prospective, single-arm, phase II clinical trial of intraoperative radiotherapy using a low-energy X-ray source for local advanced Laryngocarcinoma (ILAL): a study protocol

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