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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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Yang S, Zhang M, Chen C, Cao Y, Tian Y, Guo Y, Zhang B, Wang X, Yin L, Zhang Z, O'Dell W, Okunieff P, Zhang L. Triptolide Mitigates Radiation-Induced Pulmonary Fibrosis. Radiat Res 2015; 184:509-17. [PMID: 26488756 DOI: 10.1667/rr13831.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Triptolide (TPL) may mitigate radiation-induced late pulmonary side effects through its inhibition of global pro-inflammatory cytokines. In this study, we evaluated the effect of TPL in C57BL/6 mice, the animals were exposed to radiation with vehicle (15 Gy), radiation with TPL (0.25 mg/kg i.v., twice weekly for 1, 2 and 3 months), radiation and celecoxib (CLX) (30 mg/kg) and sham irradiation. Cultured supernatant of irradiated RAW 264.7 and MLE-15 cells and lung lysate in different groups were enzyme-linked immunosorbent assays at 33 h. Respiratory rate, pulmonary compliance and pulmonary density were measured at 5 months in all groups. The groups exposed to radiation with vehicle and radiation with TPL exhibited significant differences in respiratory rate and pulmonary compliance (480 ± 75/min vs. 378 ± 76/min; 0.6 ± 0.1 ml/cm H2O/p kg vs. 0.9 ± 0.2 ml/cm H2O/p kg). Seventeen cytokines were significantly reduced in the lung lysate of the radiation exposure with TPL group at 5 months compared to that of the radiation with vehicle group, including profibrotic cytokines implicated in pulmonary fibrosis, such as IL-1β, TGF- β1 and IL-13. The radiation exposure with TPL mice exhibited a 41% reduction of pulmonary density and a 25% reduction of hydroxyproline in the lung, compared to that of radiation with vehicle mice. The trichrome-stained area of fibrotic foci and pathological scaling in sections of the mice treated with radiation and TPL mice were significantly less than those of the radiation with vehicle-treated group. In addition, the radiation with TPL-treated mice exhibited a trend of improved survival rate compared to that of the radiation with vehicle-treated mice at 5 months (83% vs. 53%). Three radiation-induced profibrotic cytokines in the radiation with vehicle-treated group were significantly reduced by TPL treatment, and this partly contributed to the trend of improved survival rate and pulmonary density and function and the decreased severity of pulmonary fibrosis at 5 months. Our findings indicate that TPL could be a potential new agent to mitigate radiation-induced pulmonary fibrosis.
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Affiliation(s)
- Shanmin Yang
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Mei Zhang
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Chun Chen
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Yongbin Cao
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Yeping Tian
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Yangsong Guo
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Bingrong Zhang
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Xiaohui Wang
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Liangjie Yin
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Zhenhuan Zhang
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Walter O'Dell
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Paul Okunieff
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
| | - Lurong Zhang
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, Florida 32610
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Teckie S, Scala LM, Ho F, Wolden S, Chiu J, Cohen GN, Wong R, Ganly I, Zelefsky MJ, Lee NY. High-dose-rate intraoperative brachytherapy and radical surgical resection in the management of recurrent head-and-neck cancer. Brachytherapy 2013; 12:228-34. [DOI: 10.1016/j.brachy.2013.01.165] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
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Quel avenir pour la radiothérapie peropératoire ? Cancer Radiother 2009; 13:423-7. [DOI: 10.1016/j.canrad.2009.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 11/21/2022]
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Perry DJ, Chan K, Wolden S, Zelefsky MJ, Chiu J, Cohen G, Zaider M, Kraus D, Shah J, Lee N. High-dose-rate intraoperative radiation therapy for recurrent head-and-neck cancer. Int J Radiat Oncol Biol Phys 2009; 76:1140-6. [PMID: 19560882 DOI: 10.1016/j.ijrobp.2009.03.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 03/05/2009] [Accepted: 03/09/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the use of high-dose-rate intraoperative radiation therapy (HDR-IORT) for recurrent head-and-neck cancer (HNC) at a single institution. METHODS AND MATERIALS Between July 1998 and February 2007, 34 patients with recurrent HNC received 38 HDR-IORT treatments using a Harrison-Anderson-Mick applicator with Iridium-192. A single fraction (median, 15 Gy; range, 10-20 Gy) was delivered intraoperatively after surgical resection to the region considered at risk for close or positive margins. In all patients, the target region was previously treated with external beam radiation therapy (median dose, 63 Gy; range, 24-74 Gy). The 1- and 2-year estimates for in-field local progression-free survival (LPFS), locoregional progression-free survival (LRPFS), distant metastases-free survival (DMFS), and overall survival (OS) were calculated. RESULTS With a median follow-up for surviving patients of 23 months (range, 6-54 months), 8 patients (24%) are alive and without evidence of disease. The 1- and 2-year LPFS rates are 66% and 56%, respectively, with 13 (34%) in-field recurrences. The 1- and 2-year DMFS rates are 81% and 62%, respectively, with 10 patients (29%) developing distant failure. The 1- and 2-year OS rates are 73% and 55%, respectively, with a median time to OS of 24 months. Severe complications included cellulitis (5 patients), fistula or wound complications (3 patients), osteoradionecrosis (1 patient), and radiation-induced trigeminal neuralgia (1 patient). CONCLUSIONS HDR-IORT has shown encouraging local control outcomes in patients with recurrent HNC with acceptable rates of treatment-related morbidity. Longer follow-up with a larger cohort of patients is needed to fully assess the benefit of this procedure.
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Affiliation(s)
- David J Perry
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Chen AM, Bucci MK, Singer MI, Garcia J, Kaplan MJ, Chan AS, Phillips TL. Intraoperative radiation therapy for recurrent head-and-neck cancer: the UCSF experience. Int J Radiat Oncol Biol Phys 2006; 67:122-9. [PMID: 17084543 DOI: 10.1016/j.ijrobp.2006.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 08/16/2006] [Accepted: 08/17/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer. METHODS AND MATERIALS Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of definitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modified linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10-18 Gy). Median follow-up among surviving patients was 41 months (range, 3-122 months). RESULTS The 1-year, 2-year, and 3-year estimates of in-field control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-field failure (p = 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous fistula (2 patients), flap necrosis (1 patient), trismus (1 patient), and neuropathy (1 patient). CONCLUSIONS Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA.
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Calvo FA, Meirino RM, Orecchia R. intraoperative radiation therapy part 2. Clinical results. Crit Rev Oncol Hematol 2006; 59:116-27. [PMID: 16859922 DOI: 10.1016/j.critrevonc.2006.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 03/30/2006] [Accepted: 04/13/2006] [Indexed: 12/12/2022] Open
Abstract
Intraoperative radiation therapy (IORT) has been used for over 30 years in Asia, Europe and America as a supplementary activity in the treatment of cancer patients with promising results. Modern IORT is carried out with electron beams (IOERT) produced by a linear accelerator generally used for external beam irradiation (EBRT) or a specialized mobile electron accelerator. HDR brachytherapy (HDR-IORT) has also been applied on selected locations. Retrospective analysis of clinical experiences in cancer sites such as operable pancreatic tumour, locally advanced/recurrent rectal cancer, head and neck carcinomas, sarcomas and cervical cancer are consistent with local tumour control promotion compared to similar clinical experiences without IORT. New emerging indications such as the treatment of breast cancer are presented. The IORT component of the therapeutical approach allows intensification of the total radiation dose without additional exposure of healthy tissues and improves dose-deposit homogeneity and precision. Results of the application of IORT on selected disease sites are presented with an analysis on future possibilities. To improve the methodology, clinical trials are required with multivariate analysis including patient, tumour and treatment characteristics, prospective evaluation of early and late toxicity, patterns of tumour recurrence and overall patient outcome.
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Affiliation(s)
- Felipe A Calvo
- Hospital General Universitario Gregorio Marañon, Madrid, Spain.
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