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Adams SC, Nambiar AK, Bressler EM, Raut CP, Colson YL, Wong WW, Grinstaff MW. Immunotherapies for locally aggressive cancers. Adv Drug Deliv Rev 2024; 210:115331. [PMID: 38729264 DOI: 10.1016/j.addr.2024.115331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/31/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Improving surgical resection outcomes for locally aggressive tumors is key to inducing durable locoregional disease control and preventing progression to metastatic disease. Macroscopically complete resection of the tumor is the standard of care for many cancers, including breast, ovarian, lung, sarcoma, and mesothelioma. Advancements in cancer diagnostics are increasing the number of surgically eligible cases through early detection. Thus, a unique opportunity arises to improve patient outcomes with decreased recurrence rates via intraoperative delivery treatments using local drug delivery strategies after the tumor has been resected. Of the current systemic treatments (e.g., chemotherapy, targeted therapies, and immunotherapies), immunotherapies are the latest approach to offer significant benefits. Intraoperative strategies benefit from direct access to the tumor microenvironment which improves drug uptake to the tumor and simultaneously minimizes the risk of drug entering healthy tissues thereby resulting in fewer or less toxic adverse events. We review the current state of immunotherapy development and discuss the opportunities that intraoperative treatment provides. We conclude by summarizing progress in current research, identifying areas for exploration, and discussing future prospects in sustained remission.
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Affiliation(s)
- Sarah C Adams
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Arun K Nambiar
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Eric M Bressler
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Yolonda L Colson
- Massachusetts General Hospital, Department of Surgery, Boston, MA 02114, USA.
| | - Wilson W Wong
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
| | - Mark W Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA; Department of Chemistry, Boston University, Boston MA 02215, USA.
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Carvalho HDA, Mauro GP, Castilho MS. From "dose erythema" to FLASH radiotherapy: impacts on clinical practice. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S130. [PMID: 38865549 PMCID: PMC11164280 DOI: 10.1590/1806-9282.2024s130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Heloisa de Andrade Carvalho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Department of Radiology and Oncology, Radiotherapy Division (INRAD and ICESP) – São Paulo (SP), Brazil
| | - Geovanne Pedro Mauro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Department of Radiology and Oncology, Radiotherapy Division (INRAD and ICESP) – São Paulo (SP), Brazil
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Dougan M, Nguyen LH, Buchbinder EI, Lazarus HM. Sargramostim for Prophylactic Management of Gastrointestinal Immune-Related Adverse Events of Immune Checkpoint Inhibitor Therapy for Cancer. Cancers (Basel) 2024; 16:501. [PMID: 38339253 PMCID: PMC10854719 DOI: 10.3390/cancers16030501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Immune checkpoint inhibitor (ICI) therapy improves outcomes in several cancers. Unfortunately, many patients experience grade 3-4 treatment-related adverse events, including gastrointestinal (GI) toxicities which are common. These GI immune-related adverse events (irAEs) induced by ICIs present significant clinical challenges, require prompt intervention, and result in treatment delays or discontinuations. The treatment for these potentially severe and even fatal GI irAEs which include enterocolitis, severe diarrhea, and hepatitis may interfere with the anti-cancer approach. Sargramostim (glycosylated, yeast-derived, recombinant human GM-CSF) is an agent that has been used in clinical practice for more than 30 years with a well-recognized safety profile and has been studied in many therapeutic areas. The mechanism of action of sargramostim may treat moderate-to-severe GI irAEs without impairing the anti-cancer therapy. Some early data also suggest a potential survival benefit. Through the differentiation/maturation of monocytes, macrophages, and neutrophils and induction of anti-inflammatory T cell responses, GM-CSF aids in GI homeostasis, mucosal healing, and mucosal immunity. GM-CSF knockout mice are susceptible to severe colitis which was prevented with murine GM-CSF administration. For some patients with GI mucosa and immune cell function impairment, e.g., Crohn's disease, sargramostim reduces disease severity. In a prospective, randomized study (ECOG 1608), advanced melanoma patients had a reduction in grade 3-5 GI irAEs and less frequent colonic perforation in the sargramostim plus ipilimumab arm compared to ipilimumab alone. Sargramostim continues to be studied with ICIs for the prophylactic management of irAEs while also potentially providing a survival benefit.
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Affiliation(s)
- Michael Dougan
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.D.); (E.I.B.)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Long H. Nguyen
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Elizabeth I. Buchbinder
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.D.); (E.I.B.)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Hillard M. Lazarus
- Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH 44106, USA
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Lin CH, Wu CH, Lai YC, Chuang HD, Hsiao CY, Wu NS, Tseng SC, Feng CJ, Hsu SM. Technical note: Evaluation of the dose enhancement effect for a novel transmission-type x-ray tube using the Monte Carlo method. Med Phys 2023; 50:8057-8062. [PMID: 37655886 DOI: 10.1002/mp.16678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE Transmission-target x-ray tubes generate more x-rays than reflection thick-target x-ray tubes. A transmission x-ray tube combined with radiosensitizers has a better radiation enhancement effect. This study investigated the feasibility of using a transmission x-ray tube with radiosensitizers in clinical radiotherapy and its effect on radiation dose enhancement. METHODS This study used MCNP6.2 to simulate the model of a transmission x-ray tube and Co-60 beam. The radiation enhancement effect of radiosensitizers was examined with iodine-127 (I-127), radioiodinated iododeoxyuridine (IUdR), and gold nanoparticles (GNPs). RESULTS The study results showed that the dose enhancement factor (DEF) of the transmission x-ray tube with GNPs was 10.27, which was higher than that of I-127 (6.46) and IUdR (3.08). The DEF of the Co-60 beam with GNPs, I-127, and IUdR was 1.23, 1.19, and 1.2, respectively. The Auger electron flux of the transmission x-ray tube with GNPs was 1.19E+05 particles/cm2 . CONCLUSIONS This study found that a transmission x-ray tube with appropriate radiosensitizers could produce a high rate of Auger electrons to fulfill the radiation enhancement effect, and this procedure has the potential to become a radiotherapy modality.
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Affiliation(s)
- Chin-Hsiung Lin
- Medical Physics and Radiation Measurements Laboratory, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Physics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, ROC
| | - Chin-Hui Wu
- Department of Medical Imaging and Radiological Sciences, Tzu-Chi University of Science and Technology, Hualien, Taiwan, ROC
| | - Yuan-Chun Lai
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan, ROC
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Ho-Da Chuang
- Medical Physics and Radiation Measurements Laboratory, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Physics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, ROC
| | - Ching-Yu Hsiao
- Medical Physics and Radiation Measurements Laboratory, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ni-Shan Wu
- Medical Physics and Radiation Measurements Laboratory, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | | | - Chen-Ju Feng
- Medical Physics and Radiation Measurements Laboratory, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Ming Hsu
- Medical Physics and Radiation Measurements Laboratory, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Petoukhova A, Snijder R, Vissers T, Ceha H, Struikmans H. In vivodosimetry in cancer patients undergoing intraoperative radiation therapy. Phys Med Biol 2023; 68:18TR01. [PMID: 37607566 DOI: 10.1088/1361-6560/acf2e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/22/2023] [Indexed: 08/24/2023]
Abstract
In vivodosimetry (IVD) is an important tool in external beam radiotherapy (EBRT) to detect major errors by assessing differences between expected and delivered dose and to record the received dose by individual patients. Also, in intraoperative radiation therapy (IORT), IVD is highly relevant to register the delivered dose. This is especially relevant in low-risk breast cancer patients since a high dose of IORT is delivered in a single fraction. In contrast to EBRT, online treatment planning based on intraoperative imaging is only under development for IORT. Up to date, two commercial treatment planning systems proposed intraoperative ultrasound or in-room cone-beam CT for real-time IORT planning. This makes IVD even more important because of the possibility for real-time treatment adaptation. Here, we summarize recent developments and applications of IVD methods for IORT in clinical practice, highlighting important contributions and identifying specific challenges such as a treatment planning system for IORT. HDR brachytherapy as a delivery technique was not considered. We add IVD for ultrahigh dose rate (FLASH) radiotherapy that promises to improve the treatment efficacy, when compared to conventional radiotherapy by limiting the rate of toxicity while maintaining similar tumour control probabilities. To date, FLASH IORT is not yet in clinical use.
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Affiliation(s)
- Anna Petoukhova
- Haaglanden Medical Centre , Department of Medical Physics, Leidschendam, The Netherlands
| | - Roland Snijder
- Haaglanden Medical Centre , Department of Medical Physics, Leidschendam, The Netherlands
| | - Thomas Vissers
- Haaglanden Medical Centre , Medical Library, Leidschendam, The Netherlands
| | - Heleen Ceha
- Haaglanden Medical Centre , Department of Radiation Oncology, Leidschendam, The Netherlands
| | - Henk Struikmans
- Haaglanden Medical Centre , Department of Radiation Oncology, Leidschendam, The Netherlands
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Davis RW, Klampatsa A, Cramer GM, Kim MM, Miller JM, Yuan M, Houser C, Snyder E, Putt M, Vinogradov SA, Albelda SM, Cengel KA, Busch TM. Surgical Inflammation Alters Immune Response to Intraoperative Photodynamic Therapy. CANCER RESEARCH COMMUNICATIONS 2023; 3:1810-1822. [PMID: 37700795 PMCID: PMC10494787 DOI: 10.1158/2767-9764.crc-22-0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
Surgical cytoreduction for patients with malignant pleural mesothelioma (MPM) is used for selected patients as a part of multi-modality management strategy. Our group has previously described the clinical use of photodynamic therapy (PDT), a form of non-ionizing radiation, as an intraoperative therapy option for MPM. Although necessary for the removal of bulk disease, the effects of surgery on residual MPM burden are not understood. In this bedside-to-bench study, Photofrin-based PDT introduced the possibility of achieving a long-term response in murine models of MPM tumors that were surgically debulked by 60% to 90%. Thus, the addition of PDT provided curative potential after an incomplete resection. Despite this success, we postulated that surgical induction of inflammation may mitigate the comprehensive response of residual disease to further therapy. Utilizing a previously validated tumor incision (TI) model, we demonstrated that the introduction of surgical incisions had no effect on acute cytotoxicity by PDT. However, we found that surgically induced inflammation limited the generation of antitumor immunity by PDT. Compared with PDT alone, when TI preceded PDT of mouse tumors, splenocytes and/or CD8+ T cells from the treated mice transferred less antitumor immunity to recipient animals. These results demonstrate that addition of PDT to surgical cytoreduction significantly improves long-term response compared with cytoreduction alone, but at the same time, the inflammation induced by surgery may limit the antitumor immunity generated by PDT. These data inform future potential approaches aimed at blocking surgically induced immunosuppression that might improve the outcomes of intraoperative combined modality treatment. Significance Although mesothelioma is difficult to treat, we have shown that combining surgery with a form of radiation, photodynamic therapy, may help people with mesothelioma live longer. In this study, we demonstrate in mice that this regimen could be further improved by addressing the inflammation induced as a by-product of surgery.
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Affiliation(s)
- Richard W. Davis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Astero Klampatsa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gwendolyn M. Cramer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michele M. Kim
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joann M. Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Min Yuan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cassandra Houser
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emma Snyder
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Putt
- Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sergei A. Vinogradov
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven M. Albelda
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith A. Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa M. Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ji X, Ding W, Wang J, Zhou B, Li Y, Jiang W, Pan H, Gu J, Sun X. Application of intraoperative radiotherapy for malignant glioma. Cancer Radiother 2023; 27:425-433. [PMID: 37344258 DOI: 10.1016/j.canrad.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 06/23/2023]
Abstract
Malignant glioma is characterized by rapid tumor cell proliferation and high recurrence risk. In terms of its treatment, the therapeutic effects of maximum resection and postoperative radiotherapy with adjuvant chemotherapy as well as many other new therapeutic techniques such as antiangiogenic therapy and immunotherapy remain poor. Glioma recurrence, especially local recurrence, is an important reason of glioma treatment failure. Intraoperative radiotherapy (IORT) enables exclusion of radiation-sensitive normal tissue from the radiation field in operation and then the application of a single high-dose precision irradiation to the residual tumor or tumor bed. IORT has great application potential in the control of local recurrence of malignant tumors. This paper thus aims to review the current status and prospects of IORT's application in malignant glioma treatment.
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Affiliation(s)
- Xiaoqin Ji
- Department of Radiation Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wei Ding
- Department of Radiation Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jiasheng Wang
- Department of Radiation Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Zhou
- Department of Radiation Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yikun Li
- Department of Radiation Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wanrong Jiang
- Department of Radiation Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hao Pan
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jun Gu
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiangdong Sun
- Department of Radiation Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Aytac E, Sokmen S, Aktas MK, Colak T, Mentes B, Balik E, Demirbas S, Akyol C, Sungurtekin U, Oncel M, Ozturk E, Obuz F, Ucaroglu B, Leventoglu S, Ozerhan IH, Baca B, Ozgen U, Haksal M, Tumay V, Geçim E, Bugra D. Factors affecting operative morbidity and long-term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery. Colorectal Dis 2023; 25:1795-1801. [PMID: 37547974 DOI: 10.1111/codi.16697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
AIM Data regarding the operative management of presacral tumours present various dilemmas due to their rarity and heterogeneous nature. The aim of this study was to evaluate the management strategy, factors associated with operative morbidity and long-term postoperative outcomes in a large group of patients undergoing surgery for presacral tumours. METHOD This study was designed as a multicentre retrospective cohort study. Records of patients who underwent surgery for presacral tumours at 10 tertiary colorectal centres between 1996 and 2017 were evaluated. RESULTS One hundred and twenty seven patients (44 men) with a mean age of 46 years and body mass index of 27 kg/m2 were included. Fifty eight per cent of the patients had low sacral lesions (below S3). The operative approaches were transabdominal (17%), transsacral (65%) and abdominosacral (17%). The postoperative morbidity was 19%. Thirty per cent of the patients had a malignant tumour. Longer duration of symptoms (p = 0.001), higher American Society of Anesthesiologists score (p = 0.01), abdominosacral operations (p = 0.0001) and presacral tumours located above S3 (p = 0.004) were associated with an increased risk of postoperative morbidity. Overall long-term postoperative recurrence and mortality were 6% and 5%, respectively, within a 3-year mean follow-up period in patients with presacral malignant tumours. CONCLUSION Reduced physical condition, omission of symptoms prior to surgery, combined resections and high sacral tumours are the risk factors associated with postoperative complications in patients undergoing surgery for presacral tumours. Meticulous planning of the operation and intensified perioperative care may improve the outcomes in high-risk patients.
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Affiliation(s)
- Erman Aytac
- Acibadem University Atakent Hospital, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bilgi Baca
- Acibadem Altunizde Hospital, Istanbul, Turkey
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Baghani HR, Shiri A, Gholamhosseinian H. Comparing the DNA-damage RBE of intraoperative and conventional electron beams using a hybrid simulation approach. Int J Radiat Biol 2023; 100:46-60. [PMID: 37523649 DOI: 10.1080/09553002.2023.2242931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/17/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Employing electron beam for radiotherapy purposes now has been established as one of the standard cancer treatment modalities. Both dedicated intraoperative and conventional electron beams can be employed in patient irradiation. Due to the differences between accelerating structure and electron beam delivery of dedicated intraoperative radiotherapy (IORT) machines and conventional ones, the initial energy spectra of the produced electron beam by these machines may be different. Accordingly, this study aims to evaluate whether these spectral differences can affect the relevant relative biological effectiveness (RBE) values of intraoperative and conventional electron beams. MATERIALS AND METHODS A hybrid Monte Carlo simulation approach was considered. At first, the head LIAC12 machine (as an IORT accelerator) and Varian 2100C/D (as a conventional accelerator) were simulated by MCNPX code and electron energy spectra at different depths and off-axis distances were scored for two nominal electron energies of 6 and 12 MeV at the field sizes of 6 and 10 cm. Then, the calculated spectra were imported to MCDS code to estimate the induced DNA-damage RBE values. Finally, the obtained RBE values for intraoperative and conventional electron beams were compared together. RESULTS The results showed that the RBE values of the intraoperative electron beam are superior to those obtained for conventional electron beam at the same energy/field size combination. Variations of the depth can regularly affect the RBE value for both conventional and intraoperative electron beams, while no ordered variation trend was observed for RBE with changing the off-axis distance. Variations of electron energy and field size can also influence the RBE value for both types of studied electron beams. CONCLUSIONS From the results, it can be concluded the structural differences between the dedicated IORT and conventional Linacs can lead to distinct initial electron energy spectra for intraoperative and conventional electron beams. These physical differences can finally lead to different RBE values for intraoperative and conventional electron beams at the same energy and field size.
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Affiliation(s)
| | - Ali Shiri
- Medical Physics Department, Mashhad University of Medical Sciences, Mashhad, Iran
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Murphy J, Donato-Brown D, Efeotor O, Gilfillan N, Moutadjer A, Sahid S, Basak D, Perry K. A prospective case series assessing the Imperial College London intraoperative radiotherapy protocol for advanced rectal cancer: an IDEAL phase 2a study. Colorectal Dis 2023; 25:1646-1652. [PMID: 37464985 DOI: 10.1111/codi.16654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/07/2023] [Accepted: 06/03/2023] [Indexed: 07/20/2023]
Abstract
AIM Intraoperative radiotherapy (IORT) decreases local recurrence rates for advanced rectal cancer. Nevertheless, utilization of IORT is limited due to the associated logistical and financial challenges. The aim of this study is to describe the development and delivery of a novel IORT protocol for advanced rectal cancer that overcomes these difficulties in the context of the early phase of an IDEAL 2a study. The primary outcome measure was the ability to deliver IORT using this novel protocol with IORT-related toxicity as the secondary outcome measure. METHOD Consecutive patients with advanced rectal cancer expected to have involved (R1) resection margins were enrolled. After resection, 12 Gy low-energy photon IORT was delivered using the Axxent device with a custom-designed elliptical spherical balloon applicator. RESULTS Six patients with a median age of 47 years (range 33-88 years; five women) were enrolled between 2018 and 2019. The indication was advanced cancer in four patients and atypical invasive pelvic side wall lymph nodes in two. IORT was successfully delivered in all cases. No toxicity was encountered. Three advanced cancer patients had R1 resection and one had complete resection (R0); resection margin status could not be established for the two lymph node cases. Five patients were alive at 3.4 (2.9-4.1) year follow-up. None of the R1 cases recurred. CONCLUSION This is the first study to describe a novel IORT protocol using low-energy photon IORT for advanced rectal cancer. IORT could be delivered in all cases and no IORT-related toxicity was encountered. Available oncological outcome data are encouraging, but further studies will be necessary to determine the oncological effectiveness of this protocol.
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Affiliation(s)
- Jamie Murphy
- Department of Surgery, Imperial College Healthcare NHS Trust, London, UK
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, UK
| | | | - Ouvefe Efeotor
- Department of Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas Gilfillan
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Anne Moutadjer
- Department of Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Saidah Sahid
- Department of Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Dolan Basak
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Kitrick Perry
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
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11
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Hochhertz F, Hass P, Röllich B, Ochel HJ, Gawish A. A single-institution retrospective analysis of intraoperative radiation boost during breast-conservation treatment for breast cancer. J Cancer Res Clin Oncol 2023; 149:5743-5749. [PMID: 36566484 PMCID: PMC10356640 DOI: 10.1007/s00432-022-04534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND As part of a breast-conservation strategy for breast cancer, there are presently no data from randomized controlled studies on the use of intraoperative radiation (IORT) as a tumor bed boost. The effectiveness and safety of IORT as a boost therapy at a tertiary cancer center were retrospectively reviewed in this study. METHODS Patients had breast-conserving surgery from 2012 to 2016 that included staging of the axillary lymph nodes, a single dose of 20 Gy IORT with 50-kV photons, whole-breast irradiation (WBI), and (neo-)adjuvant systemic treatment (if applicable). During the follow-up patients were monitored for the assessment of acute and late toxicities (using the Common Terminology Criteria for Adverse Events version 4.03). Results included ipsilateral (IBTR), contralateral (CBE), and distant metastasis-free (DMFS) breast progression-free survival, as well as overall survival (OS). RESULTS The 68 patients had a median follow-up of 91.5 months (with a range of 9-125). Most patients (n = 51) had T1 disease and were clinically node negative. Only a small number of individuals had triple negative or high-grade illness. The majority of patients had sentinel node biopsy, and three (4.4%) had to have their tumors removed again since their original margins were positive. Finally, there were no distinct tumor bed margins. Neoadjuvant chemotherapy was administered to ten (14.7%). The median duration from BCS to WBI was 54.5 days, and conventionally fractionated WBI was used to accomplish WBI most frequently (n = 57, 96.6%). IORT was administered in a single 20 Gy dosage. 50 Gy was the median WBI dosage (range 40.05-50.4 Gy). There were no grade 4 adverse events for any patients in. Toxicities following surgery were minimal. There were only one patient with grade 3 toxicity (radiation dermatitis) to observe. Five tumor bed recurrences and two contralateral breast incident each occurred. CONCLUSION This work adds to the preliminary evidence already in the literature and supports the use of IORT in boost settings. When randomized trials like TARGIT-B are eventually published, these hopeful findings should be prospectively evaluated.
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Affiliation(s)
- Franka Hochhertz
- Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Peter Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Department of Radiation Oncology, Erfurt Helios Hospital, Erfurt, Germany
| | - Burkard Röllich
- Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Hans-Joachim Ochel
- Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Ahmed Gawish
- Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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12
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Yang Y, Li J, Qi R, Guo Y, Zhao Z, Wang M. A case of bladder urothelial carcinoma nested variant with invasion to the rectum treated with surgery and intraoperative radiotherapy. Quant Imaging Med Surg 2023; 13:5409-5416. [PMID: 37581050 PMCID: PMC10423357 DOI: 10.21037/qims-23-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/09/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Yang Yang
- Department of Colorectal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Jiannan Li
- Department of Colorectal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Rui Qi
- Department of Colorectal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Yu Guo
- Department of Colorectal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Zeyun Zhao
- Department of Colorectal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Min Wang
- Department of Colorectal Surgery, The Second Hospital of Jilin University, Changchun, China
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13
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Goerdt L, Poemsl J, Spaich S, Welzel G, Abo-Madyan Y, Ehmann M, Berlit S, Tuschy B, Sütterlin M, Wenz F, Sperk E. Longitudinal cosmetic outcome after planned IORT boost with low kV X-rays-monocentric results from the TARGIT BQR registry. Transl Cancer Res 2023; 12:1715-1726. [PMID: 37588731 PMCID: PMC10425636 DOI: 10.21037/tcr-23-88] [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: 01/20/2023] [Accepted: 06/07/2023] [Indexed: 08/18/2023]
Abstract
Background Intraoperative radiotherapy can serve as an anticipated boost (IORT boost) in combination with a subsequent external whole breast irradiation in high-risk breast cancer patients and is part of many guidelines. Nevertheless, there are only few prospective data available regarding cosmetic outcome after IORT boost using kV X-rays. The aim of this study was to evaluate the cosmetic outcome of patients treated within the prospective phase IV TARGeted Intraoperative radioTherapy (TARGIT) Boost Quality Registry (BQR) study (NCT01440010) in one center. Methods In the context of the TARGIT BQR study standardized photos in three positions (arms down, arms up, from the side) were available for different time points. For this analysis a layperson, a radiation oncologist and a gynecologist evaluated available photos at different time points during follow-up with up to 4 years using the Harvard scale (comparison of treated and the untreated breast; rating: excellent, good, fair, poor). Longitudinal results were compared to preoperative results (baseline). Results Seventy-three patients were available for the analysis. Baseline cosmetic assessment was excellent/good in 98.8% (mean value for all three positions). Postoperative cosmetic outcome (median) was good for all positions and remained constant for 4 years. Around 30% of the patients showed a constant or even improved cosmetic outcome compared to baseline. Only few patients showed a poor result at 4 years. The majority of patients showed an excellent or good cosmetic outcome at all time points. Conclusions Patients from the prospective TARGIT BQR study treated with IORT boost and additional whole breast irradiation showed good or excellent cosmetic outcomes in most cases during 4 years of follow-up. These results add important information for shared decision making in breast cancer patients.
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Affiliation(s)
- Lukas Goerdt
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Janina Poemsl
- Department of Paediatric and Adolescent Medicine, University Hospital Augsburg, Medical Faculty Augsburg, Augsburg, Germany
| | - Saskia Spaich
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- Chief Executive Officer, University Hospital Freiburg, Freiburg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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14
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Stefanelli A, Farina E, Mastella E, Fabbri S, Turra A, Bonazza S, De Troia A, Radica MK, Carcoforo P. Full-Dose Intraoperative Electron Radiotherapy for Early Breast Cancer: Evidence from a Single Center's Experience. Cancers (Basel) 2023; 15:3239. [PMID: 37370849 DOI: 10.3390/cancers15123239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
To evaluate the clinical response rate and cosmetic outcome after full-dose intraoperative electron radiotherapy (IOERT) in early breast cancer (BC) treated with conserving surgery. Inclusion criteria were: >60 years old, clinical tumor size ≤2 cm, luminal A carcinoma, patological negative lymph nodes, excluded lobular carcinoma histology. IOERT was delivered with a dose of 21 Gy at 90% isodose. Clinical, cosmetic and/or instrumental follow-up were performed 45 days after IOERT, 6 months after the first check, and every 12 months thereafter. Acute and late toxicities were assessed with the CTCAE v.4.03 and EORTC-RTOG scales, respectively. Cosmetic outcome was evaluated using the Harvard/NSABO/RTOG Breast Cosmesis Grading Scale. Overall, 162 consecutive patients were included in this analysis (median follow-up: 54 months, range: 1-98 months). The overall response rate was 97.5% (CI 95%: 0.93-0.99%). Locoragional relapse occurred in 2.5% of patients. No patient showed distant metastases. No patient showed radiation-related acute complications, with 3.7% showing late G2-3 toxicity. Only 3.7% of patients showed poor cosmetic results. Our data confirmed that IOERT is a feasible and valid therapeutic option in low-risk BC patients treated with lumpectomy. A low local recurrence rate combined with good cosmetic results validates the settings of our operative method in routinely clinical practice.
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Affiliation(s)
- Antonio Stefanelli
- Department of Radiation Oncology, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Eleonora Farina
- Department of Radiation Oncology, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Edoardo Mastella
- Department of Medical Physics, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Sara Fabbri
- Department of Medical Physics, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Alessandro Turra
- Department of Medical Physics, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Simona Bonazza
- Department of Surgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | | | | | - Paolo Carcoforo
- Department of Surgery, University Hospital of Ferrara, 44121 Ferrara, Italy
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15
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Liu S, Wei W, Wang J, Chen T. Theranostic applications of selenium nanomedicines against lung cancer. J Nanobiotechnology 2023; 21:96. [PMID: 36935493 PMCID: PMC10026460 DOI: 10.1186/s12951-023-01825-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/18/2023] [Indexed: 03/21/2023] Open
Abstract
The incidence and mortality rates of lung cancer are among the highest in the world. Traditional treatment methods include surgery, chemotherapy, and radiotherapy. Although rapid progress has been achieved in the past decade, treatment limitations remain. It is therefore imperative to identify safer and more effective therapeutic methods, and research is currently being conducted to identify more efficient and less harmful drugs. In recent years, the discovery of antitumor drugs based on the essential trace element selenium (Se) has provided good prospects for lung cancer treatments. In particular, compared to inorganic Se (Inorg-Se) and organic Se (Org-Se), Se nanomedicine (Se nanoparticles; SeNPs) shows much higher bioavailability and antioxidant activity and lower toxicity. SeNPs can also be used as a drug delivery carrier to better regulate protein and DNA biosynthesis and protein kinase C activity, thus playing a role in inhibiting cancer cell proliferation. SeNPs can also effectively activate antigen-presenting cells to stimulate cell immunity, exert regulatory effects on innate and regulatory immunity, and enhance lung cancer immunotherapy. This review summarizes the application of Se-based species and materials in lung cancer diagnosis, including fluorescence, MR, CT, photoacoustic imaging and other diagnostic methods, as well as treatments, including direct killing, radiosensitization, chemotherapeutic sensitization, photothermodynamics, and enhanced immunotherapy. In addition, the application prospects and challenges of Se-based drugs in lung cancer are examined, as well as their forecasted future clinical applications and sustainable development.
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Affiliation(s)
- Shaowei Liu
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Weifeng Wei
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jinlin Wang
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
| | - Tianfeng Chen
- College of Chemistry and Materials Science, Guangdong Provincial Key Laboratory of Functional Supramolecular Coordination Materials and Applications, Jinan University, Guangzhou, 510632, China.
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Lu Z, Xiao B, Chen W, Tang T, Zhuo Q, Chen X. The potential of ferroptosis combined with radiotherapy in cancer treatment. Front Oncol 2023; 13:1085581. [PMID: 37007068 PMCID: PMC10064444 DOI: 10.3389/fonc.2023.1085581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/10/2023] [Indexed: 03/19/2023] Open
Abstract
Ferroptosis is a new form of regulatory cell death that is closely related to the balance of redox reactions and the occurrence and development of cancer. There is increasing evidence that inducing ferroptosis in cells has great potential in the treatment of cancer. Especially when combined with traditional therapy, it can improve the sensitivity of cancer cells to traditional therapy and overcome the drug resistance of cancer cells. This paper reviews the signaling pathways regulating ferroptosis and the great potential of ferroptosis and radiotherapy (RT) in cancer treatment and emphasizes the unique therapeutic effects of ferroptosis combined with RT on cancer cells, such as synergy, sensitization and reversal of drug resistance, providing a new direction for cancer treatment. Finally, the challenges and research directions for this joint strategy are discussed.
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Affiliation(s)
- Zekun Lu
- Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Bingkai Xiao
- Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Weibo Chen
- Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Tianyu Tang
- Department of Hepatabiliary Surgery, The Second People’s Hospital of Changshu, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Qifeng Zhuo
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xuemin Chen
- Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- *Correspondence: Xuemin Chen,
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17
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Wen J, Shen H. Trend of gastric cancer incidence and death rate in adolescents and young adults: A retrospective cohort study based on the Surveillance, Epidemiology, and End Results (SEER) database. J Gastroenterol Hepatol 2023; 38:393-403. [PMID: 36403128 DOI: 10.1111/jgh.16064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/12/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIM Less attentions are paid into the adolescents and young adults (AYAs) diagnosed with gastric cancer (GC). Our study aims to explore incidence rate trend, death rate trend, and prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in AYAs with GC. METHODS A retrospective cohort study based on the Surveillance, Epidemiology, and End Results (SEER) database was performed. Joinpoint regression analysis was used to calculate average annual percent change (AAPC) with 95% confidence interval (CI) for incidence and death rate trends. Prognostic factors for OS and CSS were investigated using Cox proportional hazard model and gray test, respectively, with results shown as hazard ratio (HR) with 95% CI. RESULTS Although no statistical significance, incidence rate trend showed a tendency to an increase in AYAs (AAPC = 0.2, 95% CI: -0.2-0.6). All-cause death rate trends were declined both in AYAs and middle-aged and elderly people (MAEP), with AAPC value of -0.6 (95% CI: -0.8 to -0.5) and -0.5 (95% CI: -0.6 to -0.4), respectively. AYAs had a lower risk of all-cause death (HR: 0.87, 95% CI: 0.84-0.90) but a higher risk of GC-specific death (HR: 1.11, 95% CI: 1.07-1.15) than MAEP. Chemotherapy (HR: 1.27, 95% CI: 1.16-1.40) and intraoperative radiation (HR: 2.89, 95% CI: 1.13-7.37) were, respectively, identified as risk factors for worse OS and CSS in AYAs. CONCLUSIONS AYAs had a higher risk of GC-specific death, indicating more attention should be paid into AYAs with GC.
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Affiliation(s)
- Jie Wen
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030000, China.,The Second Clinical Medical College of Shanxi Medical University, Taiyuan, 030000, China
| | - Huiqin Shen
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030000, China
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18
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Villafuerte CVL, Ylananb AMD, Wong HVT, Cañal JPA, Fragante EJV. Systematic review of intraoperative radiation therapy for head and neck cancer. Ecancermedicalscience 2022; 16:1488. [PMID: 36819819 PMCID: PMC9934972 DOI: 10.3332/ecancer.2022.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Indexed: 12/14/2022] Open
Abstract
Multidisciplinary treatments with surgery, radiation therapy, and chemotherapy are the cornerstones in the management of locally advanced head and neck malignancies. In most cases, radiation is delivered via external beam radiation therapy (EBRT). Intraoperative radiation therapy (IORT), on the other hand, is the delivery of precise doses of radiation to selected target volumes within the exposed surgical field while at the operating room. Most studies on its use on head and neck cancers are limited to single-institutional retrospective case series. We performed a systematic review to consolidate the existing literature on IORT for head and neck malignancies. Fifty-two studies representing a mixed population of 2,389 patients were included in this review. IORT via electrons (intraoperative electron radiation therapy), brachytherapy (intraoperative high dose-rate brachytherapy) or photons was administered in numerous settings, but most commonly as part of a reirradiation regimen following salvage surgery for recurrent tumours. Often, additional EBRT was also planned postoperatively. This review illustrates that IORT is a promising treatment modality in head and neck cancer. Multiple single-institutional studies spanning several decades have demonstrated benefit in terms of local control with reasonable toxicity. However, randomised trials comparing it with current standards of care are still needed.
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19
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Impact of preoperative magnetic resonance imaging on surgery and eligibility for intraoperative radiotherapy in early breast cancer. PLoS One 2022; 17:e0274385. [PMID: 36256643 PMCID: PMC9578617 DOI: 10.1371/journal.pone.0274385] [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: 10/11/2021] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
We looked at the usefulness of magnetic resonance imaging (MRI) in decision-making and surgical management of patients selected for intraoperative radiotherapy (IORT). We also compared lesion size measurements in different modalities (ultrasound (US), mammogram (MMG), MRI) against pathological size as the gold standard. 63 patients eligible for IORT based on clinical and imaging criteria over a 34-month period were enrolled. All had MMG and US, while 42 had additional preoperative MRI for locoregional preoperative staging. Imaging findings and pathological size concordances were analysed across the three modalities. MRI changed the surgical management of 5 patients (11.9%) whereby breast-conserving surgery (BCS) and IORT was cancelled due to detection of satellite lesion, tumor size exceeding 30mm and detection of axillary nodal metastases. Ten of 42 patients (23.8%) who underwent preoperative MRI were subjected to additional external beam radiotherapy (EBRT); 7 due to lymphovascular invasion (LVI), 2 due to involved margins, and 1 due to axillary lymph node metastatic carcinoma detected in the surgical specimen. Five of 21 (23.8%) patients without prior MRI were subjected to additional EBRT post-surgery; 3 had LVI and 2 had involved margins. The rest underwent BCS and IORT as planned. MRI and MMG show better imaging-pathological size correlation. Significant increase in the mean 'waiting time' were seen in the MRI group (34.1 days) compared to the conventional imaging group (24.4 days). MRI is a useful adjunct to conventional imaging and impacts decision making in IORT. It is also the best imaging modality to determine the actual tumour size.
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Patkar S, Kattepur AK, Khanna N, Bajpai J. Retroperitoneal Sarcomas: a Current Review on Management. Indian J Surg Oncol 2022; 13:542-558. [PMID: 36187536 PMCID: PMC9515254 DOI: 10.1007/s13193-022-01520-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Retroperitoneal sarcomas are heterogeneous tumours with variable disease biology and outcomes. The prognosis is primarily related to tumour histology and grade as well as the ability to achieve margin negative resection. Surgery involves compartment or contiguous organ resection to achieve the above goal. Careful utilization of neoadjuvant and adjuvant strategies like radiotherapy and/or chemotherapy can lead to improvement in margin status, thereby contributing to better local control and possibly reducing systemic dissemination. Use of targeted therapies has paved newer pathways of treatment integration centred on molecular and genetic targets. The aim of this review is to update the reader on all aspects of retroperitoneal sarcoma management including emphasis on pertinent and landmark trials in this regard.
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Affiliation(s)
- Shraddha Patkar
- Department of Gastrointestinal Oncology, Hepatobiliary Services, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai 400012 India
| | - Abhay K. Kattepur
- Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai India
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21
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Validation of Monte Carlo-based calculations for megavolt electron beams for IORT and FLASH-IORT. Heliyon 2022; 8:e10682. [PMID: 36185136 PMCID: PMC9519483 DOI: 10.1016/j.heliyon.2022.e10682] [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: 03/23/2022] [Revised: 05/18/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Abstract
In Intra-Operative Radiation Therapy (IORT) the tumour site is surgically exposed and normal tissue located around the tumour may be avoided. Electron applicators would require large surgical incisions; therefore, the preferred mechanism for beam collimation is the IORT cone system. FLASH radiotherapy (FLASH-RT) involves the treatment of tumours at ultra-high dose rates and the IORT cone system can also be used. This study validates the Monte Carlo-based calculations for these small electron beams to accurately determine the dose characteristics of each possible cone-energy combination as well as custom-built alloy cutouts attached to the end of the IORT cone. This will contribute to accurate dose distribution and output factor calculations that are essential to all radiation therapy treatments. A Monte Carlo (MC) model was modelled for electron beams produced by a Siemens Primus LINAC and the IORT cones. The accelerator was built with the component modules available in the BEAMnrc code. The phase-space file generated by the BEAM simulation was used as the source input for the subsequent DOSXYZnrc simulations. Percentage Depth Dose (PDD) data and profiles were extracted from the dose distributions obtained with the DOSXYZnrc simulations. These beam characteristics were compared with measured data for 6, 12, and 18 MeV electron beams for the IORT open cones of diameters 19, 45, and 64 mm and irregularly shaped cutouts. The MC simulations could replicate electron beams within a criterion of 3%/3 mm. Applicator factors were within 0.7%, and cone factors showed good agreement, except for the 9 mm cone size. Based on the successful comparisons between measurement and MC-calculated dose distributions, output factors for the open cones and for small irregularly shaped IORT beams, it may be concluded that the Monte Carlo based dose calculation could replicate electron beams used for IORT and FLASH-IORT.
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22
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Rahman M, Trigilio A, Franciosini G, Moeckli R, Zhang R, Böhlen TT. FLASH radiotherapy treatment planning and models for electron beams. Radiother Oncol 2022; 175:210-221. [PMID: 35964763 DOI: 10.1016/j.radonc.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 12/18/2022]
Abstract
The FLASH effect designates normal tissue sparing at ultra-high dose rate (UHDR, >40 Gy/s) compared to conventional dose rate (∼0.1 Gy/s) irradiation while maintaining tumour control and has the potential to improve the therapeutic ratio of radiotherapy (RT). UHDR high-energy electron (HEE, 4-20 MeV) beams are currently a mainstay for investigating the clinical potential of FLASH RT for superficial tumours. In the future very-high energy electron (VHEE, 50-250 MeV) UHDR beams may be used to treat deep-seated tumours. UHDR HEE treatment planning focused at its initial stage on accurate dosimetric modelling of converted and dedicated UHDR electron RT devices for the clinical transfer of FLASH RT. VHEE treatment planning demonstrated promising dosimetric performance compared to clinical photon RT techniques in silico and was used to evaluate and optimise the design of novel VHEE RT devices. Multiple metrics and models have been proposed for a quantitative description of the FLASH effect in treatment planning, but an improved experimental characterization and understanding of the FLASH effect is needed to allow for an accurate and validated modelling of the effect in treatment planning. The importance of treatment planning for electron FLASH RT will augment as the field moves forward to treat more complex clinical indications and target sites. In this review, TPS developments in HEE and VHEE are presented considering beam models, characteristics, and future FLASH applications.
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Affiliation(s)
- Mahbubur Rahman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Antonio Trigilio
- Physics Department, "La Sapienza" University of Rome, Rome, Italy; INFN National Institute of Nuclear Physics, Rome Section, Rome, Italy
| | - Gaia Franciosini
- Physics Department, "La Sapienza" University of Rome, Rome, Italy; INFN National Institute of Nuclear Physics, Rome Section, Rome, Italy
| | - Raphaël Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Till Tobias Böhlen
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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23
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Nafissi N, Mohammadlou M, Akbari ME, Mahdavi SR, Sheikh M, Borji M, Babaee E, Baharlou R. The impact of intraoperative radiotherapy on breast cancer: focus on the levels of angiogenic factors. World J Surg Oncol 2022; 20:191. [PMID: 35681234 PMCID: PMC9178821 DOI: 10.1186/s12957-022-02653-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Angiogenesis is one of the hallmarks of cancers that is involved in tumor progression. Angiogenic factors induce the formation of new blood vessels and tumor extension, and finally reduce the survival of patients. Intraoperative radiotherapy (IORT), in which radiation is delivered to the tumor bed can kill cells and change tumor microenvironment. Here, we compared the impact of IORT on the levels of angiogenic factors in the blood and surgical wound fluids (SWF) of the breast cancer patients. PATIENTS AND METHODS Three hundred sixty patients, who had undergone breast-conserving surgery between 2013 and 2018, were enrolled in IORT and non-IORT groups non-randomly. Blood and drained wound fluid (WF) samples were collected from the patients before and after surgery, followed by quantification of the amounts of TGF-β, EGF, FGF, VEGF, and DLL4 in the patients using ELISA. RESULTS Our results were indicative of significant differences between the pre-surgery and post-surgery serum levels of EGF, DLL4, and VEGF. Furthermore, ROC analyses showed that TGF-β and DLL4 can differentiate of the early-stage from late-stage of the disease. Interestingly, the rate of the death and recurrence was reduced in IORT group. CONCLUSIONS In summary, IORT is a safe and effective treatment that can affect angiogenic factors and improve the overall- and recurrence-free survival of breast cancer patients.
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Affiliation(s)
- Nahid Nafissi
- Department of Breast, Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Mohammadlou
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Immunology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Seyed Rabie Mahdavi
- Department of Medical Physics, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Sheikh
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Borji
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Baharlou
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.
- Department of Immunology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
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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.
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Wang J, Prabhakaran S, Larach T, Warrier SK, Bednarski BK, Ngan SY, Leong T, Rodriguez-Bigas M, Peacock O, Chang G, Heriot AG, Kong JCH. Treatment strategies for locally recurrent rectal cancer. Eur J Surg Oncol 2022; 48:2292-2298. [DOI: 10.1016/j.ejso.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022] Open
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Advances in local therapy for glioblastoma - taking the fight to the tumour. Nat Rev Neurol 2022; 18:221-236. [PMID: 35277681 PMCID: PMC10359969 DOI: 10.1038/s41582-022-00621-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 12/21/2022]
Abstract
Despite advances in neurosurgery, chemotherapy and radiotherapy, glioblastoma remains one of the most treatment-resistant CNS malignancies, and the tumour inevitably recurs. The majority of recurrences appear in or near the resection cavity, usually within the area that received the highest dose of radiation. Many new therapies focus on combatting these local recurrences by implementing treatments directly in or near the tumour bed. In this Review, we discuss the latest developments in local therapy for glioblastoma, focusing on recent preclinical and clinical trials. The approaches that we discuss include novel intraoperative techniques, various treatments of the surgical cavity, stereotactic injections directly into the tumour, and new developments in convection-enhanced delivery and intra-arterial treatments.
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Hamed M, Potthoff AL, Layer JP, Koch D, Borger V, Heimann M, Scafa D, Sarria GR, Holz JA, Schmeel FC, Radbruch A, Güresir E, Schäfer N, Schuss P, Garbe S, Giordano FA, Herrlinger U, Vatter H, Schmeel LC, Schneider M. Benchmarking Safety Indicators of Surgical Treatment of Brain Metastases Combined with Intraoperative Radiotherapy: Results of Prospective Observational Study with Comparative Matched-Pair Analysis. Cancers (Basel) 2022; 14:cancers14061515. [PMID: 35326666 PMCID: PMC8946541 DOI: 10.3390/cancers14061515] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 12/07/2022] Open
Abstract
Simple Summary Patients with brain metastasis (BM) are at advanced stages of metastatic cancer, and surgical resection is often required in order to avoid severe neurologic deficits. After surgery, patients are usually committed to postoperative radiotherapy. In recent years, intraoperative radiotherapy (IORT) has been proposed as an alternative to conventional postsurgical radiation approaches. This possibility has several advantages, e.g., as IORT is administered only once during the surgical procedure, patients do not have to attend several radiotherapy sessions afterward. However, the application of radiation therapy directly into the open brain during surgery might be accompanied by severe perioperative complications and, therefore, might negatively impact the overall benefit. In the present study, we show that patients who underwent surgery for BM combined with IORT do not suffer from elevated levels of perioperative complications compared to patients without IORT. Therefore, IORT constitutes a safe treatment strategy for cancer patients with BM. Abstract Intraoperative radiotherapy (IORT) of the operative cavity for surgically treated brain metastasis (BM) has gained increasing prominence with respect to improved local tumor control. However, IORT immediately performed at the time of surgery might be associated with increased levels of perioperative adverse events (PAEs). In the present study, we performed safety metric profiling in patients who had undergone surgery for BM with and without IORT in order to comparatively analyze feasibility of IORT as an adjuvant radiation approach. Between November 2020 and October 2021, 35 patients were surgically treated for BM with IORT at our neuro-oncological center. Perioperative complication profiles were collected in a prospective observational cohort study by means of patient safety indicators (PSIs), hospital-acquired conditions (HACs), and specific cranial-surgery-related complications (CSCs) as high-standard quality metric tools and compared to those of an institutional cohort of 388 patients with BM resection without IORT in a balanced comparative matched-pair analysis. Overall, 4 out of 35 patients (11%) with IORT in the course BM resection suffered from PAEs, accounting for 3 PSIs (9%) and 1 HAC (3%). Balanced matched-pair analysis did not reveal significant differences in the perioperative complication profiles between the cohorts of patients with and without IORT (p = 0.44). Thirty-day mortality rates were 6% for patients with IORT versus 8% for patients without IORT (p = 0.73). The present study demonstrates that IORT constitutes a safe and clinically feasible adjuvant treatment modality in patients undergoing surgical resection of BM.
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Affiliation(s)
- Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
- Correspondence: (A.-L.P.); (M.S.)
| | - Julian P. Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Muriel Heimann
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Gustavo R. Sarria
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Jasmin A. Holz
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | | | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany; (F.C.S.); (A.R.)
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany; (N.S.); (U.H.)
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin, 12683 Berlin, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Frank A. Giordano
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany; (N.S.); (U.H.)
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; (J.P.L.); (D.K.); (D.S.); (G.R.S.); (J.A.H.); (S.G.); (F.A.G.); (L.C.S.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (V.B.); (M.H.); (E.G.); (P.S.); (H.V.)
- Correspondence: (A.-L.P.); (M.S.)
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Intraoperative radiotherapy for glioblastoma: A systematic review of techniques and outcomes. J Clin Neurosci 2021; 93:36-41. [PMID: 34656258 DOI: 10.1016/j.jocn.2021.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite multimodality treatment, the prognosis of glioblastoma (GBM) has remained poor. Intraoperative radiation therapy (IORT) offers additional local control by directly applying a radiation source to the resection margin, where most recurrences occur. METHODS We performed a systematic review on the oncologic outcomes and toxicities of IORT for GBM in the era of modern external beam radiation therapy (EBRT) and chemotherapy with temozolamide. RESULTS Four studies representing 123 patients were included. Majority (81%) were newly diagnosed, and gross total resection was reported in 13-80% of cases. IORT modalities included electrons from a linear accelerator (LINAC) and photons from a 50-kV x-ray device. Median doses were from 12.5 to 20 Gy for electron-based studies and 10-25 Gy for photon-based studies. Adjuvant treatment consisted of 46-60 Gy post-operative EBRT in electron-based studies and the Stupp protocol in photon-based studies. Complications included radiation necrosis (2.8-33%), infection, hematoma, perilesional edema, and wound dehiscence. Median time to local recurrence was 9.9-16 months and the reported overall progression-free survival was 11.2-12.2 months. Median overall survival was 13-14.2 months for the electron-based studies and 13.8-18 months for the photon-based studies. CONCLUSION IORT resulted in improved local control and comparable overall survival rates with the Stupp protocol. Although photon-based IORT had better results than electron IORT, this may be due to improvements in other forms of adjuvant treatment rather than the IORT modality itself. The overall effect of IORT on GBM treatment is still inconclusive due to the small number of patients and heterogeneous reporting of data.
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Lee YS, Kim HS, Cho Y, Lee IJ, Kim HJ, Lee DE, Kang HW, Park JS. Intraoperative radiation therapy induces immune response activity after pancreatic surgery. BMC Cancer 2021; 21:1097. [PMID: 34641806 PMCID: PMC8507125 DOI: 10.1186/s12885-021-08807-3] [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: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pancreatic cancer has highly aggressive features, such as local recurrence that leads to significantly high morbidity and mortality and recurrence after successful tumour resection. Intraoperative radiation therapy (IORT), which delivers targeted radiation to a tumour bed, is known to reduce local recurrence by directly killing tumour cells and modifying the tumour microenvironment. Methods Among 30 patients diagnosed with pancreatic cancer, 17 patients received IORT immediately after surgical resection. We investigated changes in the immune response induced by IORT by analysing the peritoneal fluid (PF) and blood of patients with and without IORT treatment after pancreatic cancer surgery. Further, we treated three pancreatic cell lines with PF to observe proliferation and activity changes. Results Levels of cytokines involved in the PI3K/SMAD pathway were increased in the PF of IORT-treated patients. Moreover, IORT-treated PF inhibited the growth, migration, and invasiveness of pancreatic cancer cells. Changes in lymphocyte populations in the blood of IORT-treated patients indicated an increased immune response. Conclusions Based on the characterisation and quantification of immune cells in the blood and cytokine levels in the PF, we conclude that IORT induced an anti-tumour effect by activating the immune response, which may prevent pancreatic cancer recurrence. Clinical trial registration NCT03273374. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08807-3.
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Affiliation(s)
- Yun Sun Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20, Eonju-ro 63 gil, Gangnam-gu, Seoul, 06229, South Korea.,Brain Korea 21 FOUR Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Hyung Sun Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20, Eonju-ro 63 gil, Gangnam-gu, Seoul, 06229, South Korea
| | - Yeona Cho
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Jung Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20, Eonju-ro 63 gil, Gangnam-gu, Seoul, 06229, South Korea
| | - Da Eun Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20, Eonju-ro 63 gil, Gangnam-gu, Seoul, 06229, South Korea.,Brain Korea 21 FOUR Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Hyeon Woong Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20, Eonju-ro 63 gil, Gangnam-gu, Seoul, 06229, South Korea.,Brain Korea 21 FOUR Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Joon Seong Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20, Eonju-ro 63 gil, Gangnam-gu, Seoul, 06229, South Korea.
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Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System-A Systematic Review and First Bulgarian Experience in Breast Cancer Patients. ACTA ACUST UNITED AC 2021; 28:3932-3944. [PMID: 34677253 PMCID: PMC8534590 DOI: 10.3390/curroncol28050335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022]
Abstract
(1) Background: We aimed to analyze currently available studies with intraoperative radiotherapy (IORT) as a choice of treatment where the Xoft Axxent® electronic brachytherapy (eBx) system was used as a single-dose irradiation and an exclusive radiotherapy approach at the time of surgery in patients with early breast cancer (EBC). We also compared the results of the systematic review to the Bulgarian experience. (2) Methods and Materials: We performed a systematic review of the studies published before February 2021, which investigate the application of a single-fraction 20 Gy radiation treatment, delivered at the time of lumpectomy in EBC patients with the Xoft Axxent® eBx System. A systematic search in PubMed, Scopus, and ScienceDirect was performed. The results are reported following the PRISMA guidelines. The criteria on patients’ selection for IORT (the additional need for EBRT), cosmetic outcomes, and recurrence rate from the eligible studies are compared to the treatment results in Bulgarian patients. (3) Results: We searched through 1032 results to find 17 eligible studies. There are no published outcomes from randomized trials. When reported, the cosmetic outcomes in most of the studies are defined as excellent. The observed recurrence rate is low (1–5.8%). Still, the number of patients additionally referred to postoperative external breast radiotherapy (EBRT) is up to 31%. Amongst the 20 patients treated in Bulgaria, the cosmetic outcomes are also evaluated as excellent, five of which (25%) are referred for EBRT. Within median follow-up of 39 months, there was one local and one distal recurrence. (4) Conclusions: Current evidence demonstrates the Xoft Axxent® eBx system as a safe and feasible technique for IORT delivery in EBC patients. There are no randomized controlled trials conducted at this time point to prove its long-term effectiveness. Better patient selection and a reimbursement strategy have to be proposed to extend the application of this technique in Bulgaria.
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Shamsabadi R, Baghani HR. Impact assessment of breast glandularity on relative biological effectiveness of low energy IORT X-rays through Monte Carlo simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106246. [PMID: 34218169 DOI: 10.1016/j.cmpb.2021.106246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Intraoperative radiotherapy (IORT) by low energy X-rays is a single fraction treatment modality for tumor bed irradiation after breast-conserving surgery. It has been shown that the variations of breast tissue composition can affect the absorbed dose in this method. Apart from physical quantities such as absorbed dose value, radiobiological quantities including relative biological effectiveness (RBE) may also change with the variations of breast tissue composition. Accordingly, the current study aims to quantify both single and double-strand break RBE values (RBESSB and RBEDSB) of low energy X-rays at different breast glandular fractions using a hybrid Monte Carlo (MC) simulation approach. MATERIALS AND METHODS Produced low-energy X-rays by a validated MC model of INTRABEAM machine with 50 kV nominal voltage were considered as the radiation source. The secondary electron energy spectra at various depths inside the breast tissue with different glandular fractions were scored through GEANT4 MC Toolkit. Calculated spectra were then imported to MCDS MC code for DNA strand break calculation and RBE assessment. Both RBESSB and RBEDSB were calculated for various breast glandular fractions. RESULTS Changing the breast glandularity can affect both the trend of secondary electron spectra and relevant RBE values at different depths inside the breast volume. In this regard, RBESSB increments by about 1% with increasing the breast glandular fraction from 0% to 100%. On the other hand, RBEDSB decrements by about 3.3% with increasing the glandular fraction in the range of 0% to 100%. Variations of the depth within the breast tissue can also influence the RBE value so that RBESSB reduces by about 1% with increasing the depth from 2 mm to 10 mm one, while RBEDSB increases about 3.4%. The relevant RBESSB and RBEDSB values to the entire target volume (breast PTV) respectively increment and decrement by about 0.8% and 3.2% with increasing the breast glandularity from 0% to 100%. CONCLUSION From the results, it can be concluded that the breast tissue composition has a measurable effect on RBE values of employed low energy X-rays during breast IORT which can cause variations of prescribed dose for patients with distinct breast glandularity fractions.
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Affiliation(s)
- Reza Shamsabadi
- Physics Department, Hakim Sabzevari University, Daneshgah Blvd, P.O. 9617976487, Sabzevar, Iran
| | - Hamid Reza Baghani
- Physics Department, Hakim Sabzevari University, Daneshgah Blvd, P.O. 9617976487, Sabzevar, Iran.
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Baghani HR, Nasrollahi S. Efficacy of various nanoparticle types in dose enhancement during low energy X-ray IORT: A Monte Carlo simulation study. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Intraoperative radiotherapy boost as part of breast-conservation therapy for breast cancer: a single-institution retrospective analysis. Strahlenther Onkol 2021; 197:812-819. [PMID: 33938966 PMCID: PMC8397646 DOI: 10.1007/s00066-021-01785-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
Background There are currently no data from randomized controlled trials on the use of intraoperative radiotherapy (IORT) as a tumor bed boost as part of a breast-conservation approach for breast cancer. This study retrospectively reviewed the safety and efficacy of IORT as a boost treatment at a tertiary cancer center. Methods From 2015 to 2019, patients underwent breast-conserving surgery with axillary lymph node staging and a single dose of 20 Gy IORT with 50-kV photons, followed by whole-breast irradiation (WBI) and adjuvant systemic therapy (if applicable). Patients were followed for assessment of acute and late toxicities (using the Common Terminology Criteria for Adverse Events version 5.0) at 3–6-month intervals. Outcomes included ipsilateral (IBTR) and contralateral breast progression-free survival (CBE), distant metastasis-free survival (DMFS), and overall survival (OS). Results Median follow-up for the 214 patients was 28 (range 2–59) months. Most patients had T1 disease (n = 124) and were clinically node negative. Only few patients had high-grade and/or triple-negative disease. The vast majority of patients underwent sentinel node biopsy, and 32 (15%) required re-resection for initially positive margins. Finally, all tumor bed margins were clear. Nine (4.2%) and 48 (22.4%) patients underwent neoadjuvant and adjuvant chemotherapy, respectively. WBI was predominantly performed as conventionally fractionated WBI (n = 187, 87.4%), and the median time from BCS to WBI was 54.5 days. IORT was delivered with a single dose of 20 Gy. The median WBI dose was 50 Gy (range 29.4–50.4 Gy). No patients experienced grade 4 events; acute grade 3 toxicities were limited to 17 (8%) cases of radiation dermatitis. Postoperative toxicities were mild. After WBI only one case of late grade ≥ 2 events was reported. There were two recurrences in the tumor bed and one contralateral breast event. Conclusion This investigation provides additional preliminary data supporting the using of IORT in the boost setting and corroborates the existing literature. These encouraging results should be prospectively validated by the eventual publication of randomized studies such as TARGIT‑B.
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Voogt ELK, van Rees JM, Hagemans JAW, Rothbarth J, Nieuwenhuijzen GAP, Cnossen JS, Peulen HMU, Dries WJF, Nuyttens J, Kolkman-Deurloo IK, Verhoef C, Rutten HJT, Burger JWA. Intraoperative Electron Beam Radiation Therapy (IOERT) Versus High-Dose-Rate Intraoperative Brachytherapy (HDR-IORT) in Patients With an R1 Resection for Locally Advanced or Locally Recurrent Rectal Cancer. Int J Radiat Oncol Biol Phys 2021; 110:1032-1043. [PMID: 33567303 DOI: 10.1016/j.ijrobp.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/18/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Intraoperative radiation therapy (IORT), delivered by intraoperative electron beam radiation therapy (IOERT) or high-dose-rate intraoperative brachytherapy (HDR-IORT), may reduce the local recurrence rate in patients with locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively). The aim of this study was to compare the oncological outcomes between both IORT modalities in patients with LARC or LRRC who underwent a microscopic irradical (R1) resection. METHODS All consecutive patients who received IORT because of an R1 resection of LARC or LRRC between 2000 and 2016 in two tertiary referral centers were included. In LARC, a resection margin of ≤2 mm was considered R1. A resection margin of 0 mm was considered R1 in LRRC. RESULTS In total, 215 patients with LARC were included, of whom 151 (70%) received IOERT and 64 (30%) received HDR-IORT; in addition, 158 patients with LRRC were included, of whom 112 (71%) received IOERT and 46 (29%) received HDR-IORT. After multivariable analyses, the overall survival was not significantly different between the two IORT modalities. The local recurrence-free survival was significantly longer in patients treated with HDR-IORT, both in LARC (hazard ratio [HR], 0.496; 95% CI, 0.253-0.973; P = .041) and LRRC (HR, 0.567; 95% CI, 0.349-0.920; P = .021). In patients with LARC, major postoperative complications were similar for both IORT modalities (IOERT, 30%; HDR-IORT, 27%), whereas in patients with LRRC, the incidence of major postoperative complications was higher after HDR-IORT (IOERT, 26%; HDR-IORT, 46%). CONCLUSIONS This study showed a significantly better local recurrence-free survival in favor of HDR-IORT in patients with an R1 resection for LARC or LRRC. Optimization of the IOERT technique seems warranted.
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Affiliation(s)
- Eva L K Voogt
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Jan M van Rees
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jan A W Hagemans
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost Rothbarth
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Jeltsje S Cnossen
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Heike M U Peulen
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Wim J F Dries
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Joost Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jacobus W A Burger
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Lin G, Revia RA, Zhang M. Inorganic Nanomaterial-Mediated Gene Therapy in Combination with Other Antitumor Treatment Modalities. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2007096. [PMID: 34366761 PMCID: PMC8336227 DOI: 10.1002/adfm.202007096] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 05/05/2023]
Abstract
Cancer is a genetic disease originating from the accumulation of gene mutations in a cellular subpopulation. Although many therapeutic approaches have been developed to treat cancer, recent studies have revealed an irrefutable challenge that tumors evolve defenses against some therapies. Gene therapy may prove to be the ultimate panacea for cancer by correcting the fundamental genetic errors in tumors. The engineering of nanoscale inorganic carriers of cancer therapeutics has shown promising results in the efficacious and safe delivery of nucleic acids to treat oncological diseases in small-animal models. When these nanocarriers are used for co-delivery of gene therapeutics along with auxiliary treatments, the synergistic combination of therapies often leads to an amplified health benefit. In this review, an overview of the inorganic nanomaterials developed for combinatorial therapies of gene and other treatment modalities is presented. First, the main principles of using nucleic acids as therapeutics, inorganic nanocarriers for medical applications and delivery of gene/drug payloads are introduced. Next, the utility of recently developed inorganic nanomaterials in different combinations of gene therapy with each of chemo, immune, hyperthermal, and radio therapy is examined. Finally, current challenges in the clinical translation of inorganic nanomaterial-mediated therapies are presented and outlooks for the field are provided.
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Affiliation(s)
- Guanyou Lin
- Department of Materials Science and Engineering, University of Washington, Seattle, WA 98195, USA
| | - Richard A Revia
- Department of Materials Science and Engineering, University of Washington, Seattle, WA 98195, USA
| | - Miqin Zhang
- Department of Materials Science and Engineering, University of Washington, Seattle, WA 98195, USA
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External beam radiation therapy with kilovoltage x-rays. Phys Med 2020; 79:103-112. [PMID: 33221545 DOI: 10.1016/j.ejmp.2020.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022] Open
Abstract
Kilovoltage (kV) x-rays are most commonly used for diagnostic imaging due to their sensitivity to tissue composition. In radiation therapy (RT), due to their fast attenuation, kV x-rays are typically only used for superficial irradiation of skin cancer and for intra-operative RT (IORT). Recently, however, a number of kV RT techniques have emerged. In this review article, we provide a brief overview of the use of kV x-rays for RT. Various kV x-ray source technologies suitable for RT, such as conventional x-ray tubes as well as novel x-ray sources, are first described. This x-ray source section is then followed by a section on their implementation in terms of clinical, veterinary and preclinical applications. Specifically, IORT, superficial RT and dose enhancement with iodine and gold nanoparticles, as well as microbeam RT and FLASH RT are discussed in this context. Then, a number of kV x-ray RT applications in modeling and proof-of-principle stages, such as breast external beam RT with rotational sources, kilovoltage arc therapy and the BriXS Compton pulsed x-ray sources, are reviewed. Finally, some clinical and economic considerations for the development of kV RT techniques are discussed.
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Lashkari S, Baghani HR, Tavakoli MB, Mahdavi SR. An inter-comparison between accuracy of EGSnrc and MCNPX Monte Carlo codes in dosimetric characterization of intraoperative electron beam. Comput Biol Med 2020; 128:104113. [PMID: 33197735 DOI: 10.1016/j.compbiomed.2020.104113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ionometric dosimetry in IOERT is a complicated process, due to the sophisticated beam setup and the necessity for dedicated protocols for ion chamber response correction. On the other hand, the Monte Carlo (MC) technique can easily overcome such limitations and be considered as an alternative dosimetry approach. This paper presents a comparative analysis of two widely used MC codes, EGSnrc and MCNPX, for intraoperative electron beam dosimetry. METHOD The head of LIAC12, a dedicated IOERT accelerator, was modeled by both mentioned MC codes. Then, the percentage depth dose (PDD) curves, transverse dose profiles (TDPs), and output factor (OF) values were accordingly calculated within the water phantom. To realize the accuracy of MC codes in dosimetric characterization of intraoperative electron beam, their results were finally compared with those measured by corresponding ionometric dosimetry for all forms of electron energy/applicator size. RESULTS A good agreement was observed between the simulated and measured PDDs/TDPs for both considered MC codes, such that the calculated gamma index values were always lower than unity for both considered MC codes. Nevertheless, the lower gamma index values were found in the case of the EGSnrc code. The maximum difference between the measured and calculated OF was obtained as 2.3% and 3.1% for EGSnrc and MCNPX code, respectively. CONCLUSIONS Although both studied MC codes showed compatible results with the measured ones, EGSnrc code has superior accuracy in this regard and can be considered as a more reliable toolkit in Monte Carlo-based commissioning of dedicated IOERT accelerators.
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Affiliation(s)
- Sara Lashkari
- Department of Medical Physics and Medical Engineering, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohammad Bagher Tavakoli
- Department of Medical Physics and Medical Engineering, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Seyed Rabi Mahdavi
- Medical Physics Department, Iran University of Medical Sciences, Tehran, Iran
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Commissioning, dosimetric characterization and machine performance assessment of the LIAC HWL mobile accelerator for Intraoperative Radiotherapy. Z Med Phys 2020; 30:279-288. [DOI: 10.1016/j.zemedi.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/15/2020] [Accepted: 06/03/2020] [Indexed: 01/25/2023]
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Joechle K, Gkika E, Grosu AL, Hopt UT, Neeff HP, Fichtner-Feigl S, Lang SA. [Intraoperative radiotherapy in abdominal surgery-Own experiences]. Chirurg 2020; 91:962-969. [PMID: 32270223 PMCID: PMC7581588 DOI: 10.1007/s00104-020-01165-z] [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] [Indexed: 11/25/2022]
Abstract
Hintergrund Die intraoperative Radiotherapie (IORT) kann bei lokal weit fortgeschrittenen Tumoren und zu erwartender bzw. nicht vermeidbarer R1-Situation ergänzend zur chirurgischen Resektion eingesetzt werden. Ziel ist eine verbesserte lokale Tumorkontrolle und damit ein besseres Langzeitüberleben. Indikationen sind sowohl primäre intraabdominelle und retroperitoneale Tumoren als auch Rezidivtumoren. Im Rahmen der vorliegenden Arbeit werden die eigenen Erfahrungen mit der Durchführung einer IORT bei viszeralchirurgischen Resektionen zusammengefasst. Methodik Patienten, die von Januar 2008 bis Dezember 2018 eine IORT kombiniert mit abdomineller Tumorresektion in der Klinik für Allgemein- und Viszeralchirurgie des Universitätsklinikums Freiburgs erhalten hatten, wurden in diese Arbeit eingeschlossen und hinsichtlich Kurz- und Langzeitergebnisse evaluiert. Ergebnisse Die häufigste Indikation zur Durchführung einer IORT stellten Sarkome gefolgt von Rektum- und Analkarzinomen dar. Die mediane angewandte Strahlendosis der IORT betrug 15 Gy (8–19 Gy). Bei einem medianen „comprehensive complication index“ (CCI) von 11,9 traten bei 24 % der Patienten Komplikationen (Dindo-Clavien ≥ °III) auf. Die 90-Tage-Mortalität betrug 0 %. Besonders für Analkarzinomrezidive war die lokale Kontrolle nach einem Jahr trotz R0-Resektion unzureichend. Schlussfolgerung In unserem Patientenkollektiv war die IORT mit vertretbarer Morbidität einsetzbar. Dennoch sind Indikationsstellung und Patientenselektion kritische Punkte für die Durchführung der Behandlung. Der Effekt der IORT zur Verbesserung der lokalen Kontrolle und damit auch des Langzeitüberlebens sollte in weiteren Studien evaluiert werden.
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Affiliation(s)
- Katharina Joechle
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - Eleni Gkika
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Anca-Ligia Grosu
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Ulrich T Hopt
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - Hannes P Neeff
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - Stefan Fichtner-Feigl
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - Sven A Lang
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
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Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas. Rep Pract Oncol Radiother 2020; 25:919-926. [PMID: 33088227 DOI: 10.1016/j.rpor.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022] Open
Abstract
Aim To show three patients with soft tissue sarcomas of distal extremities conservatively treated after tumor-board discussion, involving margin-free surgery, exclusive intraoperative radiotherapy, and immediate reconstruction. Background Current guidelines show clear and robust recommendations regarding the composition of the treatment of sarcomas of extremities. However, little evidence exists regarding the application of these treatments depending on the location of the primary neoplasia. Tumors that affect the distal extremities present different challenges and make multidisciplinary discussions desirable. Methods/Results We reported 3 patients who were approached with a conservative intention, after tumor board recomendation. The goals from the treatment performed were aesthetic and functional preservation, while enruring locoregional control. We had wound healing complications in 2 of the cases, requiring additional reconstruction measures. Patients are followed up for 24, 20 and 10 months; local control is 100%, and functional preservation is 100%. Conclusions Despite being a small series, it was sufficient to illustrate successful multidisciplinary planning, generating a therapeutic result with improved quality of life for patients who had an initial indication for extremity amputation.
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Akrami M, Nasrollahi H, Vahabi M, Hamedi SH, Tahmasebi S, Karbasi S, Pashnesaz M, Zangouri V, Karami MY, Mosallaei A, Talei A. Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran. Med J Islam Repub Iran 2020; 34:50. [PMID: 32884925 PMCID: PMC7456436 DOI: 10.34171/mjiri.34.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Intraoperative radiation therapy (IORT) is the delivery of radiation at the time of surgery. Whereas the dose delivered by external beam radiation therapy (EBRT) is limited by the tolerance of the surrounding normal tissues, IORT allows exclusion of a part or all of the dose-limiting sensitive structures by operative mobilization and/or direct shielding of these structures. The aim of the present study was to report the non-breast cancer patients' outcomes after receiving IORT in Shiraz, Iran. Methods: In this retrospective study, all cases who had received IORT and had non-breast malignancies were selected. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI) and computed tomography (CT). IORT was applied by self-shielded, LIAC 6-12 MeV Sordina mobile linear accelerator. Typically, a single dose of 10-21 Gy was given for maximally resected tumors. The statistical analyses were carried out using SPSS (version 21). Results: Twenty-six patients were treated with IORT alone or combined with EBRT. Different tumors were treated, including colorectal adenocarcinoma (10 cases, 38.4 %), Soft Tissue Sarcomas (STS, 11 cases, 42.3 %), head and neck cancers (3 cases, 11.5 %), one cervix malignancy case and one paravertebral fibromatosis case. Mean ± SD overall survival was 15±14.89 (0-38) and 34.3±15.72 (14-53) months for colorectal cancer and STS, respectively. Conclusion: IORT is mostly useful for pelvic and abdominal malignancies where normal bowel limits the dose that can be delivered with EBRT. However, the dose delivered in a single fraction with IORT is rarely sufficient for tumor control; therefore, IORT is usually preceded or followed by additional EBRT which should be further evaluated preferably in prospective randomized trials.
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Affiliation(s)
- Majid Akrami
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nasrollahi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Vahabi
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hassan Hamedi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Karbasi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Pashnesaz
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Yasin Karami
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Mosallaei
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrasoul Talei
- Breast Diseases Research Center, Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
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Cui TX, Dai JG, Li JM, Qian JD, Li GH, Sun JG. Safety and efficacy of INTRABEAM intraoperative radiotherapy for invasive thymoma. Medicine (Baltimore) 2020; 99:e20964. [PMID: 32629705 PMCID: PMC7337413 DOI: 10.1097/md.0000000000020964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intraoperative radiotherapy (IORT) has been used to treat different residual solid tumors after tumor removal and has shown many advantages over other treatment methods. However, the use of IORT for invasive thymoma has not been reported. Therefore, in this study, we tried to determine the safety and efficacy of INTRABEAM IORT for the treatment of invasive thymoma.Among the patients admitted to our hospital from September to December 2016 who were diagnosed with invasive thymoma, 14 were selected as study subjects. With medical histories taken beforehand, 8 of these patients were diagnosed with Masaoka stage IIA and 6 with Masaoka stage IIB; furthermore, 5 of the patients were diagnosed with myasthenia gravis (MG). INTRABEAM radiation (8-10 Gy, low energy) was delivered to the postoperative tumor bed of each patient during surgery. The intra- and postoperative complications were observed and evaluated, and the improvement in symptoms was assessed. An additional 23 patients with stage II thymoma undergoing radical surgery from April to August 2016 were chosen as the control group.One month after the operation, only 1 patient in the IORT group had cough, increased levels of leucocytes and neutrophils, and pulmonary inflammation on chest computed tomography. Reactive inflammation and pleural effusion in the 2 groups were similar (P > .05). There was no significant difference between the 2 groups in the improvement of myasthenia gravis (P > .05). Postoperative chest computed tomography and routine blood examination at 3 and 12 months showed that all the patients recovered, with normal hemogram levels and no pulmonary fibrosis around the radiation field. In addition, ultrasonic cardiography and electrocardiography demonstrated no significant difference before or after surgery within the IORT group. At the end of the follow-up, all the patients were alive, no relapse or remote metastasis was observed in the IORT group, and 2 inpatients in the control group had experienced relapse at 24 and 26 months. There was a significant difference in disease-free survival between the 2 groups (P = .00).It is safe to administer low-energy INTRABEAM IORT at a dose of approximately 10 Gy in patients with stage II invasive thymoma. INTRABEAM IORT does not significantly increase operation- or radiation-related complications and has no significant effect on vital organs such as the lungs and heart. Its long-term efficacy is worth expecting.
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Affiliation(s)
| | - Ji-gang Dai
- Department of Thoracic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jing-meng Li
- Department of Thoracic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
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Miccio JA, Oladeru OT, Jun Ma S, Johung KL. Radiation Therapy for Patients with Advanced Renal Cell Carcinoma. Urol Clin North Am 2020; 47:399-411. [PMID: 32600541 DOI: 10.1016/j.ucl.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Stereotactic radiosurgery and stereotactic body radiation therapy (SBRT) have led to a resurgence of the use of radiotherapy in the management of advanced renal cell carcinoma (RCC). These techniques provide excellent local control and palliation of metastatic sites of disease with minimal toxicity. Additionally, SBRT to the primary tumor may be efficacious and well tolerated in select patients that are not surgical candidates. Emerging data suggest that SBRT may potentiate the immune response, and current and future study will evaluate if SBRT can improve survival outcomes in patients with metastatic RCC.
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Affiliation(s)
- Joseph A Miccio
- Department of Therapeutic Radiology, Yale School of Medicine, 35 Park Street, New Haven, CT 06519, USA
| | | | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Kimberly L Johung
- Department of Therapeutic Radiology, Yale School of Medicine, 35 Park Street, New Haven, CT 06519, USA.
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Joechle K, Gkika E, Grosu AL, Lang SA, Fichtner-Feigl S. Intraoperative Strahlentherapie – Indikationen und Optionen in der Viszeralchirurgie. Chirurg 2020; 91:743-754. [DOI: 10.1007/s00104-020-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Zusammenfassung
Hintergrund
Die intraoperative Strahlentherapie (IORT) ermöglicht durch die chirurgische Exposition des Tumors und des Tumorbetts eine hohe Präzision, welche eine hohe Strahlendosis im Bereich des Tumors zulässt und gleichzeitig gesundes Gewebe als den dosislimitierenden Faktor vor Strahlung schützt. Aus diesem Grund bietet die IORT besonders dann einen Vorteil, wenn die lokale Tumorkontrolle das Langzeitüberleben entscheidend beeinflusst und Funktionserhalt ermöglicht.
Ziel der Arbeit
Die in dieser Übersichtsarbeit aufgearbeiteten Erkenntnisse aus der Literaturrecherche erlauben einen evidenzbasierten Umgang hinsichtlich Indikationen und Therapieoptionen der IORT für intraabdominelle Tumoren.
Ergebnisse und Schlussfolgerung
Die Effektivität der IORT kann anhand der vorhandenen Evidenzlage nicht abschließend beurteilt werden, jedoch ist die IORT als Ergänzung der multimodalen Therapie bei (Rezidiv‑)Rektumkarzinomen und Sarkomen aktiv im klinischen Alltag etabliert. Magen- und Pankreaskarzinome stellen weitere Indikationen dar; ergänzende Studien sind jedoch notwendig, um die Rolle der IORT hier klar zu definieren. Ein wesentlicher Faktor, damit für Patienten mit primärem Karzinom und insbesondere für Patienten mit lokalem Rezidiv verbesserte lokale Rezidiv- und Überlebensraten erreicht werden können, scheint die Patientenselektion zu sein.
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Vázquez-Vicente D, Castellanos T, Cabello A, Chacon E, Minguez JA, Chiva L. Multidisciplinary approach in the pelvic relapse of a previously irradiated cervical tumor. Int J Gynecol Cancer 2020; 30:714. [PMID: 32122948 DOI: 10.1136/ijgc-2020-001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Teresa Castellanos
- Obstetrics and Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
| | - Alvaro Cabello
- Plastic Surgery, Clinica Universitaria de Navarra, Madrid, Madrid, Spain
| | - Enrique Chacon
- Obstetrics and Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
| | - Jose Angel Minguez
- Obstetrics and Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
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Liuzzi R, Piccolo C, D'Avino V, Clemente S, Oliviero C, Cella L, Pugliese M. Dose-Response of TLD-100 in the Dose Range Useful for Hypofractionated Radiotherapy. Dose Response 2020; 18:1559325819894081. [PMID: 32110167 PMCID: PMC7019407 DOI: 10.1177/1559325819894081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose: The aim of the study was to exploit the feasibility of thermoluminescent
dosimeters (TLDs) in radiation therapy techniques in which high dose per
fraction is involved. Methods: Dose–response of TLD-100 (LiF: Mg, Ti) was investigated in both 6-MV photon
and 6-MeV electron beams. The element correction factor (ECF) generation
method was applied to check the variability of the TLDs response. Two
batches of 50 TLDs were divided into groups and exposed in the dose range 0
to 30 Gy. Regression analysis was performed with both linear and quadratic
models. For each irradiation beam, the calibration curves were obtained in 3
dose range 0 to 8 Gy, 0 to 10 Gy, and 0 to 30 Gy. The best-fitting model was
assessed by the Akaike Information Criterion test. Results: The ECF process resulted a useful tool to reduce the coefficients of
variation from original values higher than 5% to about 3.5%, for all the
batches exposed. The results confirm the linearity of dose–response curve
below the dose level of 10 Gy for photon and electron beam and the
supralinear trend above. Conclusion: The TLDs are suitable dosimeters for dose monitoring and verification in
radiation treatment involving dose up to 30 Gy in a single fraction.
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Affiliation(s)
- Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council (CNR), Naples, Italy
| | | | - Vittoria D'Avino
- Institute of Biostructure and Bioimaging, National Research Council (CNR), Naples, Italy.,National Institute for Nuclear Physics (INFN), Naples, Italy
| | | | | | - Laura Cella
- Institute of Biostructure and Bioimaging, National Research Council (CNR), Naples, Italy
| | - Mariagabriella Pugliese
- National Institute for Nuclear Physics (INFN), Naples, Italy.,Department of Physics "E. Pancini", Federico II University, Naples, Italy
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Potemin S, Kübler J, Uvarov I, Wenz F, Giordano F. Intraoperative radiotherapy as an immediate adjuvant treatment of rectal cancer due to limited access to external-beam radiotherapy. Radiat Oncol 2020; 15:11. [PMID: 31924250 PMCID: PMC6954580 DOI: 10.1186/s13014-020-1458-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neoadjuvant external-beam radiotherapy (EBRT) with concomitant chemotherapy is the current standard-of-care for locally-advanced rectal cancer. Intraoperative radiotherapy (IORT) is to date only recommended for pelvic recurrences or incompletely resectable tumors. We here report on patients with stage II/III rectal cancer that were treated with IORT in a regional Russian university center due to limited access to EBRT. METHODS We retrospectively analyzed data from patients that were diagnosed with locally-advanced rectal cancer and underwent surgery from December 2012 to October 2016 at a regional oncological center in Russia (Krasnodar). During this period, access to EBRT was limited due to a temporary lack of a sufficient number of EBRT facilities. Patients unable to travel to a distant radiotherapy site received IORT alone, those that could travel received neoadjuvant external beam (chemo-) radiotherapy. Factors of interest were tumor stage, tumor differentiation, resection status, surgery type and neoadjuvant or adjuvant chemotherapy. We assessed local progression-free survival (L-PFS), PFS and overall survival (OS). RESULTS A total of 172 patients were included in this analysis. Of those, 92 (53.5%) were treated with IORT alone (median dose: 15 Gy [8.4-17 Gy]) and 80 (46.5%) received both neoadjuvant EBRT (median dose: 50.4 Gy [40-50.4 Gy]) and IORT (median dose: 15 Gy [15-17 Gy]). The median age was 65 years [33-82]. The median follow-up was 23 months [0-63 months]. The incidence of toxicity was low in both groups with an overall complication rate of 5.4%. Local PFS at 4 years was comparable with 59.4% in the IORT group and 65.4% in the IORT/EBRT group (p = 0.70). Similarly, there was no difference in OS or PFS (p = 0.66, p = 0.51, respectively). CONCLUSIONS IORT is a valuable option for patients with locally-advanced rectal cancer in the absence of access to EBRT.
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Affiliation(s)
- Sergey Potemin
- Department of Colorectal Surgery, Regional Oncological Center of Krasnodar, Krasnodar, Russia
| | - Jens Kübler
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ivan Uvarov
- Department of Colorectal Surgery, Regional Oncological Center of Krasnodar, Krasnodar, Russia
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Intraoperative radiotherapy (IORT) versus whole-breast external beam radiotherapy (EBRT) in early stage breast cancer: results from SEER database. Jpn J Radiol 2019; 38:85-92. [PMID: 31691091 DOI: 10.1007/s11604-019-00891-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Intraoperative radiotherapy (IORT) has emerged as an alternative to whole-breast external beam radiotherapy (EBRT) for early breast cancer. This study aimed to investigate the risk factors for survival after IORT or whole-breast EBRT in breast cancer patients. MATERIALS AND METHODS Breast cancer patients undergoing IORT or whole-breast EBRT were included from the surveillance, epidemiology, and end results database. Risk factors for overall survival (OS) and cancer-specific survival (CSS) were identified by Cox proportional hazards regression analysis. RESULTS The IORT and EBRT groups did not differ significantly in OS and CSS. T2 stage (tumor size > 2 cm) was associated with poorer OS (aHR 3.49, 95% CI 1.05-11.62, P = 0.042), whereas ER-positive tumors were associated with better OS (aHR 0.26, 95% CI 0.09-0.76, P = 0.014). CONCLUSION IORT was not inferior than EBRT considering the OS and CSS in the short-term follow-up of early breast cancer. It may be a reasonable alternative to EBRT for early breast cancer in select patients with favorable tumor size and receptor status, given the need for long-term monitoring of local control and radiation toxicity.
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Pimpinella M, Andreoli S, De Angelis C, Della Monaca S, D'Arienzo M, Menegotti L. Output factor measurement in high dose-per-pulse IORT electron beams. Phys Med 2019; 61:94-102. [DOI: 10.1016/j.ejmp.2019.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
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Tam SY, Wu VWC. A Review on the Special Radiotherapy Techniques of Colorectal Cancer. Front Oncol 2019; 9:208. [PMID: 31001474 PMCID: PMC6454863 DOI: 10.3389/fonc.2019.00208] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022] Open
Abstract
Colorectal cancer is one of the commonest cancers worldwide. Radiotherapy has been established as an indispensable component of treatment. Although conventional radiotherapy provides good local control, radiotherapy treatment side-effects, local recurrence and distant metastasis remain to be the concerns. With the recent technological advancements, various special radiotherapy treatment options have been offered. This review article discusses the recently-developed special radiotherapy treatment modalities for various conditions of colorectal cancer ranging from early stage, locally advanced stage, recurrent, and metastatic diseases. The discussion focuses on the areas of feasibility, local control, and survival benefits of the treatment modalities. This review also provides accounts of the future direction in radiotherapy of colorectal cancer with emphasis on the coming era of personalized radiotherapy.
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Affiliation(s)
- Shing Yau Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Vincent W C Wu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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