Multimodality Therapy Including Surgical Resection and Intraoperative Electron Radiotherapy for Recurrent or Advanced Primary Carcinoma of the Urinary Bladder or Ureter

Hallemeier, Christopher L.; Karnes, R. Jeffrey; Pisansky, Thomas M.; Davis, Brian J.; Gunderson, Leonard L.; Leibovich, Bradley C.; Haddock, Michael G.; Choo, Richard

doi:10.1097/coc.0b013e31825d52f7

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…IORT is used to deliver high doses to the tumour in an effort to improve local control. Hallemeier et al [128] reported the use of IOERT in 17 patients after maximal resection of disease. Pre- or post-operative EBRT was used in 94% of patients.…”

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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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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“…Locoregional or node positive bladder cancer recurrence is treated as primary stage IV disease [11]. Hallemeier et al [14] described treating patients diagnosed with locoregional recurrence after radical cystectomy for bladder cancer, with a multimodality approach (combination pre/postoperative external beam radiation and/or surgical resection with or without concurrent chemotherapy). They found lower rates of subsequent recurrence, although distant recurrence was still common and survival benefit was not significantly increased [14].…”

Section: Local Recurrencementioning

confidence: 99%

“…Patients treated with radical cystectomy for locoregionally advanced (pT3-4) disease have a higher rate of locoregional recurrence [14]. Local recurrence following multimodality therapy (MMT) is approximately 3.9-31% at 5 years and up to 36% at 10 years [3 && , [8][9][10].…”

Section: Local Recurrencementioning

confidence: 99%

Managing noninvasive recurrences after definitive treatment for muscle-invasive bladder cancer or high-grade upper tract urothelial carcinoma

DiBianco

George

et al. 2015

Current Opinion in Urology

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Limited progress has been achieved in differentiating management of recurrent urothelial carcinoma from the treatment of primary urothelial carcinoma. However, there may be an increasing role for endoscopic and organ conserving therapies for carefully selected patients with recurrent noninvasive urothelial carcinoma. Identifying those at risk for early recurrence and early diagnosis of recurrence may be the most beneficial future strategies. The treatment regimen for noninvasive bladder recurrence after radical nephroureterectomy for upper tract urothelial carcinoma should include intravesical chemotherapy or Bacillus Calmette-Guerin to prevent further bladder recurrence or tumor progression. We do not advocate diversion sparing techniques for local recurrence after radical cystectomy. Metastasectomy for distant/metastatic urothelial carcinoma recurrence represents a promising area of future study.

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“…From the literature databases, 15 studies using IORT by brachytherapy implants or electrons were selected for this review [35–49] (Table 3). Brachytherapy was the most used intra-operative modality and was employed either as a single treatment or as a boost dose combined with EBRT.…”

Section: Bladder Cancermentioning

confidence: 99%

Intraoperative radiotherapy in gynaecological and genito-urinary malignancies: focus on endometrial, cervical, renal, bladder and prostate cancers

et al. 2017

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Intraoperative radiotherapy (IORT) refers to the delivery of a single radiation dose to a limited volume of tissue during a surgical procedure. A literature review was performed to analyze the role of IORT in gynaecological and genito-urinary cancer including endometrial, cervical, renal, bladder and prostate cancers.Literature search was performed by Pubmed and Scopus, using the words “intraoperative radiotherapy/IORT”, “gynaecological cancer”, “uterine/endometrial cancer”, “cervical/cervix cancer”, “renal/kidney cancer”, “bladder cancer” and “prostate cancer”. Forty-seven articles were selected from the search databases, analyzed and briefly described.Literature data show that IORT has been used to optimize local control rate in genito-urinary tumours mainly in retrospective studies. The results suggest that IORT could be advantageous in the setting of locally advanced and recurrent disease although further prospective trials are needed to confirm this findings.

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Multimodality Therapy Including Surgical Resection and Intraoperative Electron Radiotherapy for Recurrent or Advanced Primary Carcinoma of the Urinary Bladder or Ureter

Cited by 9 publications

References 15 publications

Intraoperative radiotherapy: review of techniques and results

Intraoperative radiotherapy: review of techniques and results

Managing noninvasive recurrences after definitive treatment for muscle-invasive bladder cancer or high-grade upper tract urothelial carcinoma

Intraoperative radiotherapy in gynaecological and genito-urinary malignancies: focus on endometrial, cervical, renal, bladder and prostate cancers

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