Research opportunities in intraoperative radiation therapy: the next decade 2013–2023

Calvo, Felipe A.; Sole, Claudio V.; González, M.; Tangco, E.; López-Tarjuelo, Juan; Koubychine, I.; Santos, Javíer; Pascau, Javier; Herranz, R.; Ferrer, C.

doi:10.1007/s12094-013-1019-z

Cited by 19 publications

(16 citation statements)

References 35 publications

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“…While it is debatable to rely solely on the linear quadratic model at very high doses, there is little doubt that tumor cell survival is significantly reduced when using a higher dose per fraction as compared to conventional fractionation. Moreover, there remains a need to better evaluate the effects radio-sensitizing compounds may have on normal tissue tolerances as well as tumor cell survival in the IORT setting (29). …”

Section: Radiobiology Of Iortmentioning

confidence: 99%

Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

et al. 2017

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Every year, almost 62,000 are diagnosed with a head and neck cancer (HNC) and 13,000 will succumb to their disease. In the primary setting, intraoperative radiation therapy (IORT) can be used as a boost in select patients in order to optimize local control. Addition of external beam radiation to limited volumes results in improved disease control over surgery and IORT alone. In the recurrent setting, IORT can improve outcomes from salvage surgery especially in patients previously treated with external beam radiation. The use of IORT remains limited to select institutions with various modalities being currently employed including orthovoltage, electrons, and high-dose rate brachytherapy. Practically, execution of IORT requires a coordinated effort and careful planning by a multidisciplinary team involving the head and neck surgeon, radiation oncologist, and physicist. The current review summarizes common uses, outcomes, toxicities, and technical aspects of IORT in HNC patients.

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Section: Radiobiology Of Iortmentioning

confidence: 99%

Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

et al. 2017

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“…Technological advances in mobile radiotherapy (RT) units have greatly increased the clinical application of intraoperative radiotherapy (IORT) [1–4] by providing highly localized beams of low-energy X-rays (LEX) or high-energy (MeV) electrons. The physical radiation qualities of these sources may differ to some extent from that of high-energy photons (MeV X- or γ-rays) used in conventional external beam RT, and thus potentially influence the relative biologic effectiveness (RBE).…”

Section: Introductionmentioning

confidence: 99%

Biology of high single doses of IORT: RBE, 5 R’s, and other biological aspects

Herskind

Liu

et al. 2017

Radiat Oncol

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Intraoperative radiotherapy differs from conventional, fractionated radiotherapy in several aspects that may influence its biological effect. The radiation quality influences the relative biologic effectiveness (RBE), and the role of the five R’s of radiotherapy (reassortment, repair, reoxygenation, repopulation, radiosensitivity) is different. Furthermore, putative special biological effects and the small volume receiving a high single dose may be important. The present review focuses on RBE, repair, and repopulation, and gives an overview of the other factors that potentially contribute to the efficacy. The increased RBE should be taken into account for low-energy X-rays while evidence of RBE < 1 for high-energy electrons at higher doses is presented. Various evidence supports a hypothesis that saturation of the primary DNA double-strand break (DSB) repair mechanisms leads to increasing use of an error-prone backup repair system leading to genomic instability that may contribute to inactivate tumour cells at high single doses. Furthermore, the elimination of repopulation of residual tumour cells in the tumour bed implies that some patients are likely to have very few residual tumour cells which may be cured even by low doses to the tumour bed. The highly localised dose distribution of IORT has the potential to inactivate tumour cells while sparing normal tissue by minimising the volume exposed to high doses. Whether special effects of high single doses also contribute to the efficacy will require further experimental and clinical studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0750-3) contains supplementary material, which is available to authorized users.

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“…The standard deviation of the measured absorbed doses is about two or three times the detector uncertainty, but this is not a pitfall from the point of view of the authors. To the contrary, it indicates the need for planning or imaging tools [9,22,23] to determine the in vivo tumor bed anatomy and localize the detectors more accurately.…”

Section: Discussionmentioning

confidence: 99%