1
|
Feasibility and Safety of Intraoperative Radiotherapy with Low Energy X-ray Photon Therapy for Recurrent Gynecological Cancer: A Case Series. Life (Basel) 2022; 12:life12050685. [PMID: 35629353 PMCID: PMC9143111 DOI: 10.3390/life12050685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives: To evaluate the feasibility and safety of low energy X-ray photon intraoperative radiotherapy (IORT) as an adjuvant therapy for recurrent gynecological cancer.Methods: Medical records of all recurrence gynecological cancer patients who underwent IORT were reviewed. Results: Between January 2018 and December 2021, five women (including cervical cancer (n = 2), endometrial cancer (n = 2), and uterine leiomyosarcoma (n = 1)), who underwent IORT and surgical resection for recurrent gynecologic cancer were reviewed. A median dose of 15.62 Gy (range, 12 to 20 Gy) was used for IORT. Repeated IORT and surgical resection was performed in two women. Three women experienced local recurrence, and three women died during follow-up. The 1-year local control rate was 60%. The 2-year overall survival rate was 30%. There was no Clavien–Dindo classification grade III–V complication. Conclusion: IORT using low energy X-ray photon therapy seems to be feasible and safe as an adjuvant therapy in women who underwent salvage surgery for recurrent gynecologic cancer. However, large-scale prospective studies are needed to confirm our findings and evaluate its efficacy.
Collapse
|
2
|
Angioleiomiosarcoma de clítoris. Presentación de caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
3
|
Efficacy of Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Treatment of Recurrent Uterine Sarcoma. Int J Gynecol Cancer 2018; 28:1130-1137. [DOI: 10.1097/igc.0000000000001289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
4
|
Wootton LS, Meyer J, Kim E, Phillips M. Commissioning, clinical implementation, and performance of the Mobetron 2000 for intraoperative radiation therapy. J Appl Clin Med Phys 2017; 18:230-242. [PMID: 28291922 PMCID: PMC5689882 DOI: 10.1002/acm2.12027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/17/2016] [Indexed: 12/28/2022] Open
Abstract
The Mobetron is a mobile electron accelerator designed to deliver therapeutic radiation dose intraoperatively while diseased tissue is exposed. Experience with the Mobetron 1000 has been reported extensively. However, since the time of those publications a new model, the Mobetron 2000, has become commercially available. Experience commissioning this new model and 3 years of data from historical use are reported here. Descriptions of differences between the models are emphasized, both in physical form and in dosimetric characteristics. Results from commissioning measurements including output factors, air gap factors, percent depth doses (PDDs), and 2D dose profiles are reported. Output factors are found to have changed considerably in the new model, with factors as high as 1.7 being measured. An example lookup table of appropriate accessory/energy combinations for a given target dimension is presented, and the method used to generate it described. Results from 3 years of daily QA measurements are outlined. Finally, practical considerations garnered from 3 years of use are presented.
Collapse
Affiliation(s)
- Landon S Wootton
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Juergen Meyer
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Edward Kim
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Mark Phillips
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
5
|
Intraoperative high-dose-rate brachytherapy: An American Brachytherapy Society consensus report. Brachytherapy 2017; 16:446-465. [DOI: 10.1016/j.brachy.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/19/2016] [Accepted: 01/02/2017] [Indexed: 11/22/2022]
|
6
|
Intraoperative radiation therapy (IORT) for gynecologic malignancies. Gynecol Oncol 2015; 138:449-56. [PMID: 26033307 DOI: 10.1016/j.ygyno.2015.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 01/15/2023]
Abstract
Every year almost 95,000 women are diagnosed with a gynecologic malignancy and over 28,000 women will succumb to their disease. For patients with an isolated locoregional recurrence after primary therapy, surgical resection may sometimes provide a chance of cure. To optimize the chance of local control intraoperative radiation therapy (IORT) has been used. The combination of salvage surgery and IORT has resulted in reasonable control in the IORT field. The addition of external beam radiation to limited volumes seems to result in improved disease control over surgery and IORT alone. Side effects are closely related to radical surgery, although neuropathy is seen more frequently after IORT; especially if doses of >20Gy are prescribed. Margin status remains critical, even with IORT.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW The purpose of this article is to review current evidence-based management strategies for patients with recurrent and metastatic uterine leiomyosarcoma (LMS). We will focus on treatment of advanced multifocal disease as well as new developments in targeted cancer therapies. RECENT FINDINGS The management of patients with advanced uterine LMS is divided between those with localized and those with disseminated disease. Selected patients with localized or single-organ oligometastatic disease may benefit from surgical resection. For patients with disseminated disease, fixed-dose-rate gemcitabine plus docetaxel is an appropriate first-line chemotherapy regimen. Other active cytotoxic agents include doxorubicin, ifosfamide, and dacarbazine. The role of trabectedin (approved by the European Medicine Agency to be marketed for advanced or metastatic soft tissue sarcoma) is being explored. Trials are also underway for targeted therapy in uterine LMS. Currently, the only approved targeted therapy for advanced soft tissue sarcoma is pazopanib. In patients with small volume and slowly progressive estrogen receptor/progesterone receptor-positive disease, antiestrogen therapy with an aromatase inhibitor is a reasonable alternative to observation alone. SUMMARY Despite recent advances, overall survival for advanced disease remains poor and identification of novel agents with activity in LMS is clearly needed.
Collapse
|
8
|
Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography imaging in uterine sarcomas: systematic review and meta-analysis of the literature. Int J Gynecol Cancer 2014; 23:1349-56. [PMID: 23945203 DOI: 10.1097/igc.0b013e3182a20e18] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We reviewed the medical literature on the application of fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) imaging in the management of uterine sarcomas and presented the results in systematic review and meta-analysis format. METHODS Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "PET AND (Uterine OR Uterus)" as key words. All studies evaluating the accuracy of (18)F-FDG imaging in the staging or restaging of uterine sarcomas were included if enough data could be extracted for calculation of sensitivity and/or specificity. RESULTS Eight studies were included in the systematic review. Only 2 studies reported the accuracy of (18)F-FDG PET imaging in the primary staging of uterine sarcoma with low sensitivity for lymph node staging. For restaging (detection of recurrence), all 8 included studies had quantitative data, and the patient-based pooled sensitivity and specificity were 92.1% (95% confidence interval [95% CI], 82.4-97.4) and 96.2% (95% CI, 87-99.5), respectively. On a lesion-based analysis, sensitivity was 86.3% (95% CI, 76.7-92.9), and specificity was 94.4% (95% CI, 72.7-99.9). Device used (PET vs PET/CT), spectrum of studied patients, and histology of the sarcoma seem to be factors influencing the overall accuracy of (18)F-FDG PET imaging. CONCLUSIONS (8)Fluorine-18-fluorodeoxyglucose PET and PET/CT seem to be accurate methods for detection and localization of recurrence in patients with uterine sarcoma. Further large multicenter studies are needed to validate our results and to correlate both sarcoma type and spectrum of patients to the diagnostic performance of (18)F-FDG PET imaging in recurrence detection. The studies evaluating the accuracy of (18)F-FDG PET imaging for the primary staging of uterine sarcoma are very limited, and no definite conclusion can be made in this regard.
Collapse
|
9
|
Sole CV, Calvo FA, de Sierra PA, Herranz R, Gonzalez-Bayon L, García-Sabrido JL. Multidisciplinary therapy for patients with locally oligo-recurrent pelvic malignancies. J Cancer Res Clin Oncol 2014; 140:1239-48. [PMID: 24718720 DOI: 10.1007/s00432-014-1667-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/28/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To analyze prognostic factors and long-term outcomes in patients with locally recurrent pelvic cancer (LRPC) treated with a multidisciplinary approach. METHODS AND MATERIALS From January 1995 to December 2011, 81 patients [rectal (47 %); gynecologic (39 %); retroperitoneal sarcoma (14 %)] underwent extended surgery [multiorgan (58 %), bone (35 %), vascular (9 %), soft tissue (63 %)] and intraoperative electron beam radiation therapy (IOERT) to treat recurrent tumors in the pelvic region. Thirty-five patients (43 %) received external beam radiotherapy (EBRT). Survival was estimated using the Kaplan-Meier method, and risk factors were identified using univariate and multivariate analysis. RESULTS Median follow-up was 39 months (6-189 months); the 1- 3- and 5-year rates of locoregional control (LRC) were 83, 53, and 41 %, respectively. Univariate Cox proportional hazard analysis revealed worse LRC in patients who did not receive integrated EBRT as rescue treatment of pelvic recurrence (p = 0.003) or underwent non-radical resection (p = 0.01). In the multivariate analysis EBRT, non-radical resection, and tumor fragmentation retained significance (p = 0.002, p = 0.004, and p = 0.05, respectively). CONCLUSIONS Radical resection, absence of tumor fragmentation and addition of EBRT for rescue are associated with improved LRC in patients with LRPC. Our results suggest that this group can benefit from EBRT combined with extended surgical resection and IOERT.
Collapse
Affiliation(s)
- Claudio V Sole
- Service of Radiation Oncology, Instituto de Radiomedicina, Ave. Americo Vespucio Norte, 1314, 7630370, Santiago, Chile,
| | | | | | | | | | | |
Collapse
|
10
|
Gao Y, Liu Z, Gao F, Chen X. Intraoperative radiotherapy in stage IIB adenocarcinoma of the uterine cervix: a retrospective study. Onco Targets Ther 2013; 6:1695-700. [PMID: 24348047 PMCID: PMC3838758 DOI: 10.2147/ott.s53020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Adenocarcinoma (AC) of the uterine cervix has a poor prognosis and is usually fatal. The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced AC. Methods Twenty-seven women were treated with IOERT. Surgery consisted of gross negative surgical margins in 19 patients, positive surgical margins in two patients, and close surgical margins in six patients. Twenty-three patients received chemotherapy. Results The 5-year overall survival and disease-free survival rates were 21/27 (77.8%) and 19/27 (70.4%), respectively. A significantly better survival rate was found in patients with AC compared to patients with adenosquamous carcinoma. Tumor recurrence and metastasis were observed in seven patients (25.9%). No central failure occurred whether or not the resection margins were positive. Two (7.4%) patients developed peripheral neurotoxicity. Conclusion IOERT plus surgery may be feasible and effective with a low risk of toxicity, even in patients with positive resection margins.
Collapse
Affiliation(s)
- Ying Gao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Zi Liu
- Department of Radiotherapy Oncology, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Fei Gao
- Department of Surgery, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xi Chen
- Department of Surgery, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, People's Republic of China
| |
Collapse
|
11
|
Sole C, Calvo F, Lozano M, Gonzalez-Bayon L, Gonzalez-Sansegundo C, Alvarez A, Lizarraga S, García-Sabrido J. External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer. Strahlenther Onkol 2013; 190:171-80. [DOI: 10.1007/s00066-013-0472-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/16/2013] [Indexed: 01/14/2023]
|
12
|
Debenham BJ, Hu KS, Harrison LB. Present status and future directions of intraoperative radiotherapy. Lancet Oncol 2013; 14:e457-e464. [PMID: 24079873 DOI: 10.1016/s1470-2045(13)70270-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this Review, we summarise recent published work on the use of intraoperative radiotherapy to treat common tumour sites in the primary or recurrent setting. Techniques, radiobiology, and the physics of intraoperative radiotherapy are also explored. Disease sites discussed in this Review include head and neck cancer, breast cancer, sarcoma, gastrointestinal cancer, genitourinary cancer, gynaecological cancer, thoracic cancer, and palliative applications.
Collapse
Affiliation(s)
- Brock J Debenham
- Department of Radiation Oncology, Continuum Cancer Centers of New York-Beth Israel Medical Center, St Luke's and Roosevelt Hospitals, New York, NY 10003, USA
| | - Kenneth S Hu
- Department of Radiation Oncology, Continuum Cancer Centers of New York-Beth Israel Medical Center, St Luke's and Roosevelt Hospitals, New York, NY 10003, USA.
| | - Louis B Harrison
- Department of Radiation Oncology, Continuum Cancer Centers of New York-Beth Israel Medical Center, St Luke's and Roosevelt Hospitals, New York, NY 10003, USA
| |
Collapse
|
13
|
Calvo F, Sole C, Lozano M, Gonzalez-Bayon L, Gonzalez-Sansegundo C, Alvarez A, Blanco J, Calín A, Lizarraga S, García-Sabrido J. Intraoperative electron beam radiotherapy and extended surgical resection for gynecological pelvic recurrent malignancies with and without external beam radiation therapy: Long-term outcomes. Gynecol Oncol 2013; 130:537-44. [DOI: 10.1016/j.ygyno.2013.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 11/16/2022]
|