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Intraoperative radiation after pelvic short course radiation-based total neoadjuvant therapy for patients with rectal adenocarcinoma at high risk for local recurrence. Clin Colorectal Cancer 2022; 21:204-211. [DOI: 10.1016/j.clcc.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/21/2022]
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2
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Winkler P, Odreitz-Stark S, Haas E, Thalhammer M, Partl R. Commissioning, dosimetric characterization and machine performance assessment of the LIAC HWL mobile accelerator for Intraoperative Radiotherapy. Z Med Phys 2020; 30:279-288. [PMID: 32682654 DOI: 10.1016/j.zemedi.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/15/2020] [Accepted: 06/03/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The LIAC HWL (Sordina IORT Technologies, Vicenza, Italy) is a recently designed mobile linear accelerator for intraoperative electron radiotherapy (IOeRT), producing high dose rate electron beams at four different energy levels. It features a software tool for the visualization of 2D dose distributions, which is based on Monte Carlo simulations. The aims of this work were to (i) assess the dosimetric characteristics of the accelerator, (ii) experimentally verify calculated data exported from the software and (iii) report on commissioning as well as performance of the system during the first year of operation. METHODS The electron energies of the LIAC HWL used in this study are 6, 8, 10 and 12 MeV. Diameters of the cylindrically shaped applicators range from 3 to 10cm. We studied two applicator sets with different length ratios of proximal and terminal applicator sections. Reference dosimetry, linearity as well as short- and long-term stability were measured with a PTW Advanced Markus chamber, relative depth dose and profiles were measured using an unshielded diode. Percentage-depth-dose (PDD) and transversal dose profile (TDP) data were exported from the simulation software LIACSim and compared with our measurements. RESULTS The device reaches dose rates up to 40Gy/min (for 12 MeV). Surface doses for the 10cm applicators are higher than 90%, X-ray background is below 0.6% for all energies. Simulations and measurements of PDD agreed well, with a maximum difference in the depth of the 50% isodose of 0.7mm for the flat-ended applicators and 1mm for the beveled applicators. The simulations slightly underestimate the dose in the lateral parts of the field (difference < 1.8% for flat-ended applicators). The two different applicator sets were dosimetrically equivalent. Long-term stability measurements for the first year of operation ranged from -2.1% to 1.6% (mean: -0.1%). CONCLUSIONS The system is dosimetrically well suited for IOeRT and performed stably and reliably. The software tool for visualization of dose distributions can be used to support treatment planning, following thorough validation.
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Affiliation(s)
- Peter Winkler
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbrugger Platz 32, A-8036 Graz, Austria.
| | - Stefan Odreitz-Stark
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbrugger Platz 32, A-8036 Graz, Austria
| | - Eva Haas
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbrugger Platz 32, A-8036 Graz, Austria
| | - Martin Thalhammer
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbrugger Platz 32, A-8036 Graz, Austria
| | - Richard Partl
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbrugger Platz 32, A-8036 Graz, Austria
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3
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Adrich P. Technical Note: Monte Carlo study on the reduction in x-ray contamination of therapeutic electron beams for Intraoperative Radiation Therapy by means of improvements in the design of scattering foils. Med Phys 2019; 46:3378-3384. [PMID: 31173366 DOI: 10.1002/mp.13647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/29/2019] [Accepted: 05/22/2019] [Indexed: 11/11/2022] Open
Abstract
PURPOSE This work is aimed at studying the feasibility of reducing stray x-ray contamination of therapeutic electron beams used in Intraoperative Radiation Therapy (IOERT) through improvements in the design of the dual foil beam forming system. METHODS We assess the validity of a known method for designing the primary scattering foil. To this end, we perform, for the first time, a systematic computational study of the performance of beam forming systems equipped with primary scattering foils of different thicknesses, including a foil designed according to the currently used method. In this study, we further develop and apply a recently proposed method for optimization of dual foil systems. RESULTS For each of the considered primary foils, a secondary foil that minimizes the stray x-ray contamination was designed under additional conditions on the clinically acceptable therapeutic range and flatness of off-axis dose profile. For comparison, we also designed secondary foils that enable the production of the best flattened beams irrespective of x-ray contamination and therapeutic range. CONCLUSIONS By means of a comparative analysis, we demonstrated that currently employed design methods do not lead to an optimal solution in terms of stray x-ray contamination and therapeutic range. It is further demonstrated that, in comparison to older designs, reduction in x-ray contamination exceeding 30% may be expected in a system designed using the novel method developed here. Such a reduction is beneficial for IOERT delivered in a regular, unshielded operating room.
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Marinetto E, Victores JG, García-Sevilla M, Muñoz M, Calvo FÁ, Balaguer C, Desco M, Pascau J. Technical Note: Mobile accelerator guidance using an optical tracker during docking in IOERT procedures. Med Phys 2017; 44:5061-5069. [PMID: 28736930 DOI: 10.1002/mp.12482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Intraoperative electron radiation therapy (IOERT) involves the delivery of a high radiation dose during tumor resection in a shorter time than other radiation techniques, thus improving local control of tumors. However, a linear accelerator device is needed to produce the beam safely. Mobile linear accelerators have been designed as dedicated units that can be moved into the operating room and deliver radiation in situ. Correct and safe dose delivery is a key concern when using mobile accelerators. The applicator is commonly fixed to the patient's bed to ensure that the dose is delivered to the prescribed location, and the mobile accelerator is moved to dock the applicator to the radiation beam output (gantry). In a typical clinical set-up, this task is time-consuming because of safety requirements and the limited degree of freedom of the gantry. The objective of this study was to present a navigation solution based on optical tracking for guidance of docking to improve safety and reduce procedure time. METHOD We used an optical tracker attached to the mobile linear accelerator to track the prescribed localization of the radiation collimator inside the operating room. Using this information, the integrated navigation system developed computes the movements that the mobile linear accelerator needs to perform to align the applicator and the radiation gantry and warns the physician if docking is unrealizable according to the available degrees of freedom of the mobile linear accelerator. Furthermore, we coded a software application that connects all the necessary functioning elements and provides a user interface for the system calibration and the docking guidance. RESULT The system could safeguard against the spatial limitations of the operating room, calculate the optimal arrangement of the accelerator and reduce the docking time in computer simulations and experimental setups. CONCLUSIONS The system could be used to guide docking with any commercial linear accelerator. We believe that the docking navigator we present is a major contribution to IOERT, where docking is critical when attempting to reduce surgical time, ensure patient safety and guarantee that the treatment administered follows the radiation oncologist's prescription.
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Affiliation(s)
- Eugenio Marinetto
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Mónica García-Sevilla
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mercedes Muñoz
- Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Felipe Ángel Calvo
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Balaguer
- Department of Systems Engineering and Automation, Universidad Carlos III, Madrid, Spain
| | - Manuel Desco
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Pascau
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Abdelfatah E, Page A, Sacks J, Pierorazio P, Bivalacqua T, Efron J, Terezakis S, Gearhart S, Fang S, Safar B, Pawlik TM, Armour E, Hacker-Prietz A, Herman J, Ahuja N. Postoperative complications following intraoperative radiotherapy in abdominopelvic malignancy: A single institution analysis of 113 consecutive patients. J Surg Oncol 2017; 115:883-890. [PMID: 28252805 DOI: 10.1002/jso.24597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/28/2016] [Accepted: 02/09/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intraoperative radiotherapy (IORT) has advantages over external beam radiation therapy (EBRT). Few studies have described side effects associated with its addition. We evaluated our institution's experience with abdominopelvic IORT to assess safety by postoperative complication rates. METHODS Prospectively collected IRB-approved database of all patients receiving abdominopelvic IORT (via high dose rate brachytherapy) at Johns Hopkins Hospital between November 2006 and May 2014 was reviewed. Patients were discussed in multidisciplinary conferences. Those selected for IORT were patients for whom curative intent resection was planned for which IORT could improve margin-negative resection and optimize locoregional control. Perioperative complications were classified via Clavien-Dindo scale for postoperative surgical complications. RESULTS A total of 113 patients were evaluated. Most common diagnosis was sarcoma (50/113, 44%) followed by colorectal cancer (45/113, 40%), most of which were recurrent (84%). There were no perioperative deaths. A total of 57% of patients experienced a complication Grade II or higher: 24% (27/113) Grade II; 27% (30/113) Grade III; 7% (8/113) Grade IV. Wound complications were most common (38%), then gastrointestinal (25%). No radiotherapy variables were significantly associated with complications on uni/multi-variate analysis. CONCLUSIONS Our institution's experience with IORT demonstrated historically expected postoperative complication rates. IORT is safe, with acceptable perioperative morbidity.
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Affiliation(s)
- Eihab Abdelfatah
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Page
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Sacks
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip Pierorazio
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trinity Bivalacqua
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Efron
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Terezakis
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Gearhart
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sandy Fang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elwood Armour
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Hacker-Prietz
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Herman
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nita Ahuja
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kyrgias G, Hajiioannou J, Tolia M, Kouloulias V, Lachanas V, Skoulakis C, Skarlatos I, Rapidis A, Bizakis I. Intraoperative radiation therapy (IORT) in head and neck cancer: A systematic review. Medicine (Baltimore) 2016; 95:e5035. [PMID: 27977569 PMCID: PMC5268015 DOI: 10.1097/md.0000000000005035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Multimodality therapy constitutes the standard treatment of advanced and recurrent head and neck cancer. Since locoregional recurrence comprises a major obstacle in attaining cure, the role of intraoperative radiation therapy (IORT) as an add-on in improving survival and local control of the disease has been investigated. IORT allows delivery of a single tumoricidal dose of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. Advantages of IORT include the conformal delivery of a large dose of radiation in an exposed and precisely defined tumor bed, minimizing the risk of a geographic miss creating the potential for subsequent dose reduction of external beam radiation therapy (EBRT). This strategy allows for shortening overall treatment time and dose escalation. The aim of this review is to summarize recent published work on the use of IORT as an adjuvant modality to treat common head and neck cancer in the primary or recurrent setting. METHODS We searched the Medline, Scopus, Ovid, Cochrane, Embase, and ISI Web of Science databases for articles published from 1980 up to March 2016. RESULTS Based on relevant publications it appears that including IORT in the multimodal treatment may contribute to improved local control. However, the benefit in overall survival is not so clear. CONCLUSION IORT seems to be a safe, promising adjunct in the management of head and neck cancer and yet further well organized clinical trials are required to determine its role more precisely.
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Affiliation(s)
| | - Jiannis Hajiioannou
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
| | - Maria Tolia
- Department of Radiotherapy/Radiation Oncology
| | - Vassilios Kouloulias
- 2nd Department of Radiology-Radiotherapy Unit, ATTIKON University Hospital, Medical School, University of Athens
| | - Vasileios Lachanas
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
| | - Charalambos Skoulakis
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
| | - Ioannis Skarlatos
- Hellenic Anticancer Institute, St-Savvas Anticancer Hospital, Athens, Greece
| | - Alexandros Rapidis
- Hellenic Anticancer Institute, St-Savvas Anticancer Hospital, Athens, Greece
| | - Ioannis Bizakis
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
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Automated construction of an intraoperative high-dose-rate treatment plan library for the Varian brachytherapy treatment planning system. Brachytherapy 2016; 15:531-536. [DOI: 10.1016/j.brachy.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 11/17/2022]
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Bert J, Lemaréchal Y, Visvikis D. New hybrid voxelized/analytical primitive in Monte Carlo simulations for medical applications. Phys Med Biol 2016; 61:3347-64. [PMID: 27032813 DOI: 10.1088/0031-9155/61/9/3347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Monte Carlo simulations (MCS) applied in particle physics play a key role in medical imaging and particle therapy. In such simulations, particles are transported through voxelized phantoms derived from predominantly patient CT images. However, such voxelized object representation limits the incorporation of fine elements, such as artificial implants from CAD modeling or anatomical and functional details extracted from other imaging modalities. In this work we propose a new hYbrid Voxelized/ANalytical primitive (YVAN) that combines both voxelized and analytical object descriptions within the same MCS, without the need to simultaneously run two parallel simulations, which is the current gold standard methodology. Given that YVAN is simply a new primitive object, it does not require any modifications on the underlying MC navigation code. The new proposed primitive was assessed through a first simple MCS. Results from the YVAN primitive were compared against an MCS using a pure analytical geometry and the layer mass geometry concept. A perfect agreement was found between these simulations, leading to the conclusion that the new hybrid primitive is able to accurately and efficiently handle phantoms defined by a mixture of voxelized and analytical objects. In addition, two application-based evaluation studies in coronary angiography and intra-operative radiotherapy showed that the use of YVAN was 6.5% and 12.2% faster than the layered mass geometry method, respectively, without any associated loss of accuracy. However, the simplification advantages and differences in computational time improvements obtained with YVAN depend on the relative proportion of the analytical and voxelized structures used in the simulation as well as the size and number of triangles used in the description of the analytical object meshes.
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Affiliation(s)
- Julien Bert
- INSERM UMR1101, LaTIM, CHRU Brest, Brest, France
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9
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Intraoperative radiotherapy with low energy photons in recurrent colorectal cancer: a single centre retrospective study. Contemp Oncol (Pozn) 2016; 20:52-7. [PMID: 27095940 PMCID: PMC4829748 DOI: 10.5114/wo.2016.58500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Intraoperative radiotherapy (IORT) may improve outcome of surgical treatment of recurrent colorectal cancer (CRC). The aim of this study is to determine the feasibility, safety and long-term results of surgical treatment of recurrent CRC with orthovolt IORT. MATERIAL AND METHODS Fifty-nine consecutive CRC patients with local recurrence (LR), undergoing surgery, were included in the retrospective analysis of prospectively collected data. The modified Wanebo classification was used to stage LR (Tr). Twenty-five (43%) patients received IORT using INTRABEAM(®) PRS 500. The complications were classified according to the Clavien-Dindo classification. RESULTS There were 32 males and 27 females, with a median age of 63 years. Multi-visceral resections were performed in 37 (63%) patients. Median hospitalization time after surgery with IORT was 7 days. One (1.7%) in-hospital postoperative death was reported. Grade 3/4 postoperative complications were found in 11 (19%) patients. Intraoperative radiotherapy had no effect on the postoperative hospitalization time, morbidity and mortality. Median survival after R0 resection was 32 months. Complete resection (R0), no synchronous liver metastases (M0), and no lateral and posterior pelvic wall involvement, were significant predictors of improved survival. Stage of LR was found to be an independent prognostic factor in the multivariate analysis (p = 0.03); Cox regression model). In patients with LR stage < Tr5, a 3-year overall survival (OS) rate was 52%. CONCLUSIONS Combination of surgical resection and orthovolt IORT is a safe and feasible procedure that does not increase the risk of postoperative complications or prolongs the hospital stay. Despite aggressive surgery supported by IORT, the advanced stage of LR is a limiting factor of long-term survival.
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10
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Salvage surgery and radiotherapy including intraoperative electron radiotherapy in isolated locally recurrent tumors: Predictors of outcome. Radiother Oncol 2015; 116:316-22. [DOI: 10.1016/j.radonc.2015.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 11/18/2022]
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11
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Haynes AB, Bloom ES, Bedrosian I, Kuerer HM, Hwang RF, Munsell MF, Chemaly RF, Graviss LS, Caudle AS, Hunt KK, Tereffe W, Shaitelman SF, Babiera GV. Timing of infectious complications following breast-conserving therapy with catheter-based accelerated partial breast irradiation. Ann Surg Oncol 2014; 21:2512-6. [PMID: 24736987 DOI: 10.1245/s10434-014-3528-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) has been used as an alternative to whole-breast irradiation as part of breast-conserving therapy. Indications and outcomes are topics of ongoing investigation. Previous publications have focused on early postoperative infections and reported low rates of delayed infection. We investigated the pattern of infection after catheter-based APBI at our institution. METHODS Patients who underwent single-entry catheter-based APBI were identified from an institutional prospective registry including data regarding comorbidities and outcomes. Time of infection was calculated from the date of definitive catheter insertion and classified as early (≤30 days) or delayed. RESULTS A total of 91 breast cancer patients were treated with APBI and enrolled in the registry from 2009 to 2011. The median follow-up was 484 days. Breast infection occurred in 13 (14.3 %), with 3 (3.3 %) occurring within 30 days of catheter placement and 10 (11.0 %) in a delayed fashion. Four patients required hospital admission, five underwent percutaneous aspiration, and one underwent incision and drainage. Eight were treated as outpatients with oral antibiotics alone. CONCLUSIONS Consistent with other reports, we found an overall infection rate of 14.3 % with single-entry catheter-based APBI. There were substantially fewer infections in the early postoperative period than reported elsewhere, but there were more delayed infections. The intensive follow-up in our study likely identified late infections that may not have otherwise been recognized. Vigilance for infectious complications must continue beyond the immediate treatment period in patients undergoing catheter-based APBI. These infections can range in severity but typically can be managed in an outpatient setting.
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Affiliation(s)
- Alex B Haynes
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Sole CV, Calvo FA, Serrano J, Del Valle E, Rodriguez M, Muñoz-Calero A, Turégano F, García-Sabrido JL, Garcia-Alfonso P, Peligros I, Rivera S, Deutsch E, Alvarez E. Post-chemoradiation intraoperative electron-beam radiation therapy boost in resected locally advanced rectal cancer: long-term results focused on topographic pattern of locoregional relapse. Radiother Oncol 2014; 112:52-8. [PMID: 24997989 DOI: 10.1016/j.radonc.2014.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/25/2014] [Accepted: 05/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with locally advanced rectal cancer (LARC) have a dismal prognosis. We investigated outcomes and risk factors for locoregional recurrence (LRR) in patients treated with preoperative chemoradiotherapy (CRT), surgery and IOERT. METHODS A total of 335 patients with LARC [⩾cT3 93% and/or cN+ 69%) were studied. In multivariate analyses, risk factors for LRR, IFLR and OFLR were assessed. RESULTS Median follow-up was 72.6 months (range, 4-205). In multivariate analysis distal margin distance ⩽10 mm [HR 2.46, p = 0.03], R1 resection [HR 5.06, p = 0.02], tumor regression grade 1-2 [HR 2.63, p = 0.05] and tumor grade 3 [HR 7.79, p < 0.001] were associated with an increased risk of LRR. A risk model was generated to determine a prognostic index for individual patients with LARC. CONCLUSIONS Overall results after multimodality treatment of LARC are promising. Classification of risk factors for LRR has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment.
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Affiliation(s)
- Claudio V Sole
- Department of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Felipe A Calvo
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Serrano
- School of Medicine, Complutense University, Madrid, Spain; Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Del Valle
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marcos Rodriguez
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Muñoz-Calero
- School of Medicine, Complutense University, Madrid, Spain; Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Turégano
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose Luis García-Sabrido
- School of Medicine, Complutense University, Madrid, Spain; Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Garcia-Alfonso
- School of Medicine, Complutense University, Madrid, Spain; Service of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Peligros
- Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sofia Rivera
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Molecular Radiotherapy Laboratory INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; School of Medicine, Paris-Sud University, Villejuif, France
| | - Eric Deutsch
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Molecular Radiotherapy Laboratory INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; School of Medicine, Paris-Sud University, Villejuif, France
| | - Emilio Alvarez
- School of Medicine, Complutense University, Madrid, Spain; Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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13
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Calvo FA, Murillo LA, Sallabanda M, Martinez-Villanueva J, Sole CV. Imaging opportunities for treatment planning in intraoperative electron beam radiotherapy (IOERT): Developments in the context of RADIANCE system. Rep Pract Oncol Radiother 2014. [DOI: 10.1016/j.rpor.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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High-dose-rate intraoperative radiation therapy: the nuts and bolts of starting a program. J Contemp Brachytherapy 2014; 6:99-105. [PMID: 24790628 PMCID: PMC4003434 DOI: 10.5114/jcb.2014.42027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/01/2014] [Accepted: 03/28/2014] [Indexed: 12/05/2022] Open
Abstract
High-dose-rate intraoperative radiation therapy (HDR-IORT) has historically provided effective local control (LC) for patients with unresectable and recurrent tumors. However, IORT is limited to only a few specialized institutions and it can be difficult to initiate an HDR-IORT program. Herein, we provide a brief overview on how to initiate and implement an HDR-IORT program for a selected group of patients with gastrointestinal and pelvic solid tumors using a multidisciplinary approach. Proper administration of HDR-IORT requires institutional support and a joint effort among physics staff, oncologists, surgeons, anesthesiologists, and nurses. In order to determine the true efficacy of IORT for various malignancies, collaboration among institutions with established IORT programs is needed.
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Calvo F, Sole C, Herranz R, Lopez-Bote M, Pascau J, Santos A, Muñoz-Calero A, Ferrer C, Garcia-Sabrido J. Intraoperative radiotherapy with electrons: fundamentals, results, and innovation. Ecancermedicalscience 2013; 7:339. [PMID: 24009641 PMCID: PMC3757959 DOI: 10.3332/ecancer.2013.339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Indexed: 11/23/2022] Open
Abstract
Rationale and objectives To analyse the programme activity and clinical innovation and/or technology developed over a period of 17 years with regard to the introduction and the use of intraoperative radiotherapy (IORT) as a therapeutic component in a medical–surgical multidisciplinary cancer hospital. Material and methods To standardise and record this procedure, the Radiation Oncology service has an institutional programme and protocols that must be completed by the different specialists involved. For 17 years, IORT procedures were recorded on a specific database that includes 23 variables with information recorded on institutional protocols. As part of the development and innovation activity, two technological tools were implemented (RADIANCE and MEDTING) in line with the standardisation of this modality in clinical practice. Results During the 17 years studied, 1,004 patients were treated through 1,036 IORT procedures. The state of the disease at the time of IORT was 77% primary and 23% recurrent. The origin and distribution of cancers were 62% gastrointestinal, 18% sarcomas, 5% pancreatic, 2% paediatric, 3% breast, 7% less common locations, and 2% others. The research and development projects have generated a patent on virtual planning (RADIANCE) and proof of concept to explore as a professional social network (MEDTING). During 2012, there were 69 IORT procedures. There was defined treatment volume (target or target region) in all of them, and 43 were conducted by the virtual planning RADIANCE system. Eighteen have been registered on the platform MEDTING as clinical cases. Conclusion The IORT programme, developed in a university hospital with an academic tradition, and interdisciplinary surgical oncology, is a feasible care initiative, able to generate the necessary intense clinical activity for tending to the cancer patient. Moreover, it is a competitive source for research, development, and scientific innovation.
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Affiliation(s)
- Fa Calvo
- Department of Oncology, Gregorio Marañón General University Hospital, Madrid 28007, Spain ; School of Medicine, Complutense University, Madrid, Spain ; Institute of Research Investigation, Gregorio Marañón General University Hospital, Madrid 28007, Spain
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16
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Calvo FA, Sole CV, Obregón R, Gómez-Espí M, González-San Segundo C, González-Bayón L, Alvarez E, García-Sabrido JL. Intraoperative radiotherapy for the treatment of resectable locally advanced gastric adenocarcinoma: topography of locoregional recurrences and long-term outcomes. Clin Transl Oncol 2012; 15:443-9. [PMID: 23143948 DOI: 10.1007/s12094-012-0949-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/20/2012] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To report feasibility, tolerance, anatomical sites of upper abdominal locoregional recurrence and long-term outcome of gastric cancer patients treated with surgery and a component of intraoperative electron beam radiotherapy (IORT). MATERIALS AND METHODS From January 1995 to December 2010, 32 patients with primary gastric adenocarcinoma treated with curative resection (R0) [total gastrectomy (n = 9; 28 %), subtotal (n = 23; 72 %) and D2 lymphadenectomy in all patients] and apparent disease confined to locoregional area [Stage: II (n = 15; 47 %), III (n = 17; 53 %)] were treated with a component of IORT (IORT applicator size 5-9 cm in diameter, dose 10-15 Gy, beam energy 6-5 MeV) over the celiac axis and peripancreatic nodal areas. Sixteen (50 %) patients also received adjuvant treatment (external beam radiotherapy n = 6, chemoradiation n = 9, chemotherapy alone n = 1). RESULTS With a median follow-up time of 40 months (range, 2-60), locoregional recurrence was observed in five (16 %) patients (4 nodal in hepatic hilum and 1 anastomotic). Only pN1 patients developed locoregional relapse. No recurrence was observed in the IORT-treated target volume (celiac trunk and peripancreatic nodes). Overall survival at 5 years was 54.6 % (95 % CI: 48.57-60.58). Postoperative mortality was 6 % (n = 2) and postoperative complications 19 % (n = 6). CONCLUSIONS It is feasible to integrate IORT as a component of radiotherapy in combined modality therapy of gastric cancer. Local control is high in the radiation boosted area, but marginal regional extension (in particular, involving the hepatic hilum) might be considered as part of the anatomic IORT target volume at risk in pN+ patients.
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Affiliation(s)
- F A Calvo
- Department of Oncology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007, Madrid, Spain
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17
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Calvo F, González M, González-San Segundo C, González-Bayón L, Lozano M, Santos-Miranda J, Álvarez E, García-Sabrido J. Surgery and intraoperative electron radiotherapy in recurrent or metastatic oligotopic extrapelvic cancer: Long-term outcome. Eur J Surg Oncol 2012; 38:955-61. [DOI: 10.1016/j.ejso.2012.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/18/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022] Open
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Abstract
The investigational nature of partial breast irradiation (PBI) remains an area of controversy in the field of breast radiotherapy. While we have a long track record of conducting and strongly supporting the research in this area, we have chosen the more cautious approach of continuing to offer PBI only as part of a trial, open to selected breast cancer patients at low risk of local recurrence. This position reflects the fact that existing whole breast radiotherapy has revealed very successful in controlling local recurrences and it remains the safest choice for the patient. Our thinking has been reinforced by the recent data linking the prevention of recurrence to long term breast cancer survival: until more is known about PBI safety, its indiscriminate use may deprive some women from their best chance of fighting breast cancer. Considerations regarding the correct interpretation of the available evidence in view of the still limited duration of follow up and of the pattern of local recurrence of breast cancer sustain our position that PBI can be offered only in the context of a clinical trial. Unfortunately, more time and data are warranted for PBI to be legitimately recognized a standard radiotherapy approach in breast conservation therapy.
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19
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May intra-operative radiotherapy have a role in the treatment of prostate cancer? Crit Rev Oncol Hematol 2012; 83:123-9. [DOI: 10.1016/j.critrevonc.2011.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/15/2011] [Accepted: 08/18/2011] [Indexed: 11/24/2022] Open
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Zhang Q, Tey J, Peng L, Yang Z, Xiong F, Jiang R, Liu T, Fu S, Lu JJ. Adjuvant chemoradiotherapy with or without intraoperative radiotherapy for the treatment of resectable locally advanced gastric adenocarcinoma. Radiother Oncol 2011; 102:51-5. [PMID: 22178689 DOI: 10.1016/j.radonc.2011.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 09/26/2011] [Accepted: 10/16/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE To document the long-term efficacy of intraoperative electron radiotherapy (IOERT) followed by concurrent chemotherapy and external-beam radiotherapy (EBRT) in the management of locally advanced gastric cancer. MATERIALS AND METHODS A total of 97 consecutive patients with T3/4 or N+ gastric adenocarcinoma were enrolled. Fifty-one patients received adjuvant chemoradiotherapy (EBRT group) and 46 received IOERT (dose range, 12-15 Gy) followed by chemoradiotherapy (EBRT+IOERT group). RESULTS The 5-year locoregional control rates were 50% and 35% in the two groups with or without IOERT, respectively (p=0.04). Two patients had recurrence within the IOERT field in the EBRT+IOERT group and 14 patients recurred in the same area in the EBRT group (p=0.02). Multivariate analyses revealed that adjuvant IOERT was an independent prognosticator for both local-regional control (p=0.02) and disease-free survival (p=0.05). G3/4 late toxicity was observed in 5 patients in the EBRT+IOERT group, but none in the EBRT group (p=0.02). CONCLUSIONS Higher radiation dose may contribute to the improvement of local control, especially in the field encompassed by IOERT. The addition of IOERT to surgery and adjuvant chemoradiation deserves further investigation in a randomized trial.
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Affiliation(s)
- Qing Zhang
- Department of Radiation Oncology, Sixth Hospital of Jiao Tong University, Shanghai, People's Republic of China
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21
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Ruano-Ravina A, Cantero-Muñoz P, Eraso Urién A. Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review. Cancer Lett 2011; 313:15-25. [PMID: 21930343 DOI: 10.1016/j.canlet.2011.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/04/2011] [Accepted: 08/22/2011] [Indexed: 11/27/2022]
Abstract
The objective of this study is to assess the efficacy and safety of intraoperative radiotherapy (IORT) for early breast cancer through a systematic review. Fifteen studies met the inclusion criteria. Most studies assessed the combined treatment with IORT (10-24Gy) and external beam radiotherapy (EBRT) (45-50Gy) on early stage breast cancer (T(0-2)). Local control was over 95% for 1 and 4years of follow-up and the 5-year overall survival was 99%. The TARGIT-A study found a similar survival comparing IORT with standard treatment. The incidence of acute and chronic complications was scarce. IORT is well tolerated by patients and acute and late toxicities are low. There are no differences in survival for IORT treated patients versus standard treatment.
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Affiliation(s)
- A Ruano-Ravina
- Galician Agency for Health Technology Assessment, Galician Department of Health, Spain.
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Zeidan YH, Yeh A, Weed D, Terry C, Freeman S, Krowiak E, Borrowdale R, Huntley T. Intraoperative radiation therapy for advanced cervical metastasis: a single institution experience. Radiat Oncol 2011; 6:72. [PMID: 21676211 PMCID: PMC3141525 DOI: 10.1186/1748-717x-6-72] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/15/2011] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis. METHODS Between August 1982 and July 2007, 231 patients underwent neck dissections as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%). RESULTS 1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities. CONCLUSIONS IORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.
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Affiliation(s)
- Youssef H Zeidan
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
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Zeidan YH, Shiue K, Weed D, Johnstone PA, Terry C, Freeman S, Krowiak E, Borrowdale R, Huntley T, Yeh A. Intraoperative radiotherapy for parotid cancer: a single-institution experience. Int J Radiat Oncol Biol Phys 2011; 82:1831-6. [PMID: 21514074 DOI: 10.1016/j.ijrobp.2011.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 02/08/2011] [Accepted: 02/17/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Our practice policy has been to provide intraoperative radiotherapy (IORT) at resection to patients with head-and-neck malignancies considered to be at high risk of recurrence. The purpose of the present study was to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland. METHODS AND MATERIALS Between 1982 and 2007, 96 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. The median age was 62.9 years (range, 14.3-88.1). Of the 96 patients, 33 had previously undergone external beam radiotherapy as a component of definitive therapy. Also, 34 patients had positive margins after surgery, and 40 had perineural invasion. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons. The median follow-up period was 5.6 years. RESULTS Only 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 1, 3, and 5 years was 82.0%, 68.5%, and 65.2%, respectively. The 1-, 3-, and 5-year overall survival rate after surgery and IORT was 88.4%, 66.1%, and 56.2%, respectively. No perioperative fatalities occurred. Complications developed in 26 patients and included vascular complications in 7, trismus in 6, fistulas in 4, radiation osteonecrosis in 4, flap necrosis in 2, wound dehiscence in 2, and neuropathy in 1. Of these 26 patients, 12 had recurrent disease, and 8 had undergone external beam radiotherapy before IORT. CONCLUSIONS IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.
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Affiliation(s)
- Youssef H Zeidan
- Department of Radiation Oncology, Methodist Hospital, Indianapolis, IN, USA.
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Cantero-Muñoz P, Urién MA, Ruano-Ravina A. Efficacy and safety of intraoperative radiotherapy in colorectal cancer: a systematic review. Cancer Lett 2011; 306:121-33. [PMID: 21414718 DOI: 10.1016/j.canlet.2011.02.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 01/15/2023]
Abstract
Intraoperative radiotherapy (IORT) has been proposed as an encouraging treatment for colorectal cancer. The aim of this study is to assess the efficacy and safety of IORT for this cancer through a systematic review. Studies located in electronic databases were selected according to established criteria, read and analysed and the results extracted by two independent reviewers. Fifteen studies met the selection criteria. Five-to-six-year local control (LC) was over 80% and 5-year overall survival (OS) was close to 65%. For recurrences, the 5-year overall survival was 30%. The main acute complications were gastrointestinal. Adding IORT to conventional treatment reduces the incidence of local recurrences within the radiation area over 10%. IORT is a safe technique as it does not increase toxicity associated with conventional treatment.
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Affiliation(s)
- P Cantero-Muñoz
- Galician Agency for Health Technology Assessment, Galician Department of Health, Spain
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25
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Rodriguez-Paz JM, Mark LJ, Herzer KR, Michelson JD, Grogan KL, Herman J, Hunt D, Wardlow L, Armour EP, Pronovost PJ. A Novel Process for Introducing a New Intraoperative Program: A Multidisciplinary Paradigm for Mitigating Hazards and Improving Patient Safety. Anesth Analg 2009; 108:202-10. [DOI: 10.1213/ane.0b013e31818ca423] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pawlik TM, Ahuja N, Herman JM. The role of radiation in retroperitoneal sarcomas: a surgical perspective. Curr Opin Oncol 2007; 19:359-66. [PMID: 17545800 DOI: 10.1097/cco.0b013e328122d757] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review focuses on the current concepts relating to the use of radiation therapy in the care of surgical patients with retroperitoneal sarcoma. Radiation therapy for retroperitoneal sarcoma patients is complex because it requires decisions on not only the timing of administration, but also the technique of delivery. RECENT STUDIES Multiple studies have reported improved local recurrence-free survival in patients who received adjuvant external beam radiation therapy. Recent studies have demonstrated the efficacy of more sophisticated delivery methods for radiation therapy to deliver high dose rates while sparing surrounding normal tissues. Other recent studies have demonstrated the safety and feasibility of preoperative radiation therapy for retroperitoneal sarcoma. Preoperative radiation results in decreased local recurrence rates and minimal toxicity. The use of intraoperative radiation therapy has also been examined as a means to improve local recurrence rates, but may be associated with more radiation-related morbidity. SUMMARY There is good evidence that radiation therapy improves local control rates. Preoperative external beam radiation therapy may be the preferred sequence to improve tumor resectability and local-regional control with less risk of complications. Although data suggest that the addition of intraoperative radiation therapy to external beam radiation therapy improves local control, intraoperative radiation therapy may be related to additional toxicity.
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Affiliation(s)
- Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 22187-6681, USA.
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Yaar M, Eller MS, Panova I, Kubera J, Wee LH, Cowan KH, Gilchrest BA. Telomeric DNA induces apoptosis and senescence of human breast carcinoma cells. Breast Cancer Res 2007; 9:R13. [PMID: 17257427 PMCID: PMC1851376 DOI: 10.1186/bcr1646] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 11/22/2006] [Accepted: 01/26/2007] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Cancer is a leading cause of death in Americans. We have identified an inducible cancer avoidance mechanism in cells that reduces mutation rate, reduces and delays carcinogenesis after carcinogen exposure, and induces apoptosis and/or senescence of already transformed cells by simultaneously activating multiple overlapping and redundant DNA damage response pathways. METHODS The human breast carcinoma cell line MCF-7, the adriamycin-resistant MCF-7 (Adr/MCF-7) cell line, as well as normal human mammary epithelial (NME) cells were treated with DNA oligonucleotides homologous to the telomere 3' overhang (T-oligos). SCID mice received intravenous injections of MCF-7 cells followed by intravenous administration of T-oligos. RESULTS Acting through ataxia telangiectasia mutated (ATM) and its downstream effectors, T-oligos induced apoptosis and senescence of MCF-7 cells but not NME cells, in which these signaling pathways were induced to a far lesser extent. In MCF-7 cells, experimental telomere loop disruption caused identical responses, consistent with the hypothesis that T-oligos act by mimicking telomere overhang exposure. In vivo, T-oligos greatly prolonged survival of SCID mice following intravenous injection of human breast carcinoma cells. CONCLUSION By inducing DNA damage-like responses in MCF-7 cells, T-oligos provide insight into innate cancer avoidance mechanisms and may offer a novel approach to treatment of breast cancer and other malignancies.
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Affiliation(s)
- Mina Yaar
- Department of Dermatology, Boston University School of Medicine, Albany Street Boston, MA 02118-2394, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Albany Street, Boston, MA 02118-2394, USA
| | - Mark S Eller
- Department of Dermatology, Boston University School of Medicine, Albany Street Boston, MA 02118-2394, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Albany Street, Boston, MA 02118-2394, USA
| | - Izabela Panova
- Department of Dermatology, Boston University School of Medicine, Albany Street Boston, MA 02118-2394, USA
| | - John Kubera
- Department of Dermatology, Boston University School of Medicine, Albany Street Boston, MA 02118-2394, USA
| | - Lee Hng Wee
- Department of Dermatology, Boston University School of Medicine, Albany Street Boston, MA 02118-2394, USA
| | - Kenneth H Cowan
- Cancer Center, Boston University School of Medicine, Albany Street, Boston, MA 02118-2394, USA
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, 68198-6805, USA
| | - Barbara A Gilchrest
- Department of Dermatology, Boston University School of Medicine, Albany Street Boston, MA 02118-2394, USA
- Cancer Center, Boston University School of Medicine, Albany Street, Boston, MA 02118-2394, USA
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Abstract
Breast-conserving treatment is considered the standard therapy for most early-stage breast cancer and has given excellent results. That notwithstanding in the last years, several institutions are trying to revisit the adjuvant radiation treatment setting, especially with respect to possible changes in overall treatment time and target volume within the philosophy of modern partial breast irradiation. Up to date, no conclusive data are available on the possible role of partial breast irradiation in early-stage breast cancer but in this paper, we review the rationale and the researches currently being undertaken within the framework of this approach, trying to answer whether, in spite of the absence of the randomized evidence of the equivalence between whole and partial breast irradiation, could be already possible to suggest this treatment modality in the daily clinical practice, at least in some selected cases.
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Affiliation(s)
- R Orecchia
- Department of Radio-Oncology, European Institute of Oncology, Milan, Italy.
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