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

Voogt, E L K; Rees, Jan M. van; Hagemans, J.A.W.; Rothbarth, Joost; Nieuwenhuijzen, Grard A. P.; Cnossen, Jeltsje S.; Peulen, Heike M.U.; Dries, Wim; Nuyttens, J.; Kolkman-Deurloo, I.K.K.; Verhoef, Cornelis; Rutten, H.J.T.; Burger, Jacobus W. A.

doi:10.1016/j.ijrobp.2021.02.006

Cited by 13 publications

(24 citation statements)

References 27 publications

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“…Hepatocellular carcinoma cells have a high sensitivity to radiation, which could mean a similar control rate to squamous cell carcinoma is possible. The dosimetry advantages and clinical benefits of IOERT have been demonstrated among various malignancies (10)(11)(12)(13)(14)(15)(16)(17)(18). In our study there were 15 (40.5%) patients with recurrence, nine of which (24.3%) experienced early recurrence, but no patients had marginal recurrence compared with Yu W, et al, who reported a recurrence rate of 50.8% after resection alone (35).…”

Section: Feasibility Considerationssupporting

confidence: 51%

“…In contrast to external-beam radiation therapy (EBRT), a single high-dose of radiation produces a higher biological effect and has the advantages of eliminating the residual micro-lesions in the tumor bed, and at the same time, intra-and interfractional motion is reduced and the dose applied more homogeneously. This technique provides more patient comfort and reduces total treatment time by one to five weeks (10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…IOERT as an adjuvant therapy has been used to treat head and neck, breast, prostate and gastrointestinal cancers, as well as retroperitoneal and extremity sarcomas (10)(11)(12)(13)(14)(15)(16)(17)(18). However, the application of IOERT is not well understood in CL-HCC patients.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome of Centrally Located Hepatocellular Carcinomas Treated by Radical Resection Combined With Intraoperative Electron Radiotherapy (IOERT)

Zhai²,

Li³

et al. 2022

Front. Oncol.

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PurposeTo explore the feasibility and safety of centrally located hepatocellular carcinoma (CL-HCC) treated by narrow-margin resection combined with intraoperative electron radiotherapy (IOERT).Methods and MaterialsFrom November 2009 to November 2016, 37 consecutive patients were treated with IOERT as adjuvant treatment during narrow-margin resection for CL-HCC. Long-term outcomes, adverse events for surgery, and acute and chronic toxicities were analyzed.ResultsThe median follow-up was 57.82 months (range, 3.75-111.41 months). A total dose of 15 Gy (range 12 to 17Gy) (prescribed at the 90% isodose) was delivered with a 0.9cm (range 0.8-1.2 cm) median treatment depth targeting the narrow-margin. The 1-year, 3-year and 5-year OS rates were 91.39%, 88.34% and 88.34%, respectively. The 1-year, 3-year and 5-year DFS rates were 80.81%, 68.59% and 54.17%, respectively. In the univariate analysis, none of the treatment characteristics were predictive of overall survival. Fifteen (40.5%) patients suffered from a recurrence event. No patient had marginal recurrence. The 1-year, 3-year and 5-year intrahepatic recurrence rates were 19.75%, 25.92% and 39.58%, respectively. The 1-year, 3-year and 5-year extrahepatic recurrence rates were 2.7%, 5.95% and 9.87%, respectively. There was no 30-day surgical-related death. Three patients had grade 4, and 28 patients had grade 3 alanine aminotransferase (ALT) levels, and seven patients had grade 4, and 30 patients had grade 3 aspartate transaminase (AST) levels. All of them returned to normal within four months. There was no acute radiation-induced liver injury during follow-up. There were no acute or chronic toxicities associated with IOERT.ConclusionIOERT for narrow-margin CL-HCC may achieve good long-term survival outcomes, without significantly increasing acute and chronic toxicities. An IOERT dose of 15Gy may be the safest and most feasible. IOERT might be considered as an adjuvant therapy for CL-HCC patients with a narrow-margin.

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Section: Feasibility Considerationssupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome of Centrally Located Hepatocellular Carcinomas Treated by Radical Resection Combined With Intraoperative Electron Radiotherapy (IOERT)

Zhai²,

Li³

et al. 2022

Front. Oncol.

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“…The last technique is currently used occasionally, and will therefore not be discussed further in this paper [ 11 ]. A recently published study compared outcomes for both methods (IOERT in Catharina Cancer Institute [CCI] in Eindhoven, The Netherlands, and IOBT in Erasmus Medical Center [EMC] in Rotterdam, The Netherlands) in patients with an R1 resection for locally advanced and locally recurrent rectal cancer [ 12 ]. Results from this paper showed a significantly better local recurrence-free survival favoring IOBT.…”

Section: Purposementioning

confidence: 99%

“…At the Catharina Cancer Institute (CCI) in Eindhoven (NL), IOERT is delivered via a Mobetron 2000 [ 12 ] (IntraOp Medical, Sunnycale CA 94085), one of the commercially available mobile linear accelerators. The available energies at CCI are 6, 9, and 12 MeV.…”

Section: Introductionmentioning

confidence: 99%

Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer

Verrijssen¹,

Dries²,

Cnossen³

et al. 2022

jcb

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Purpose: Intra-operative radiotherapy (IORT) has been used as a tool to provide a high-dose radiation boost to a limited volume of patients with fixed tumors with a likelihood of microscopically involved resection margins, in order to improve local control. Two main techniques to deliver IORT include high-dose-rate (HDR) brachytherapy, termed 'intra-operative brachytherapy' (IOBT), and electrons, termed 'intra-operative electron radiotherapy' (IOERT), both having very different dose distributions. A recent paper described an improved local recurrence-free survival favoring IOBT over IOERT for patients with locally advanced or recurrent rectal cancer and microscopically irradical resections. Although several factors may have contributed to this result, an important difference between the two techniques was the higher surface dose delivered by IOBT. This article described an adaptation of IOERT technique to achieve a comparable surface dose as dose delivered by IOBT.Material and methods: Two steps were taken to increase the surface dose for IOERT: 1. Introducing a bolus to achieve a maximum dose on the surface, and 2. Re-normalizing to allow for the same prescribed dose at reference depth.Conclusions: We describe and propose an adaptation of IOERT technique to increase surface dose, decreasing the differences between these two techniques, with the aim of further improving local control. In addition, an alternative method of dose prescription is suggested, to consider improved comparison with other techniques in the future.

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Outcome of intraoperative brachytherapy as a salvage treatment for locally recurrent rectal cancer

Stoian,

Neeff,

Gainey

et al. 2024

Strahlenther Onkol

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Background Locally advanced recurrent rectal cancer (RRC) requires a multimodal approach. Intraoperative high-dose-rate brachytherapy (HDR-BT) may reduce the risk of local recurrence. However, the optimal therapeutic regimen remains unclear. The aim of this retrospective monocentric study was to evaluate the toxicity of HDR-BT after resection of RRC. Methods Between 2018 and 2022, 17 patients with RRC received resection and HDR-BT. HDR-BT was delivered alone or as an anticipated boost with a median dose of 13 Gy (range 10–13 Gy) using an 192iridium microSelectron HDR remote afterloader (Elekta AB, Stockholm, Sweden). All participants were followed for assessment of acute and late adverse events using the Common Terminology Criteria for Adverse Events version 5.0 and the modified Late Effects in Normal Tissues criteria (subjective, objective, management, and analytic; LENT-SOMA) at 3‑ to 6‑month intervals. Results A total of 17 patients were treated by HDR-BT with median dose of 13 Gy (range 10–13 Gy). Most patients (47%) had an RRC tumor stage of cT3‑4 N0. At the time of RRC diagnosis, 7 patients (41.2%) had visceral metastases (hepatic, pulmonary, or peritoneal) in the sense of oligometastatic disease. The median interval between primary tumor resection and diagnosis of RRC was 17 months (range 1–65 months). In addition to HDR-BT, 2 patients received long-course chemoradiotherapy (CRT; up to 50.4 Gy in 1.8-Gy fractions) and 2 patients received short-course CRT up to 36 Gy in 2‑Gy fractions. For concomitant CRT, all patients received 5‑fluorouracil (5-FU) or capecitabine. Median follow-up was 13 months (range 1–54). The most common acute grade 1–2 toxicities were pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and lymphedema in 2 patients (11.8%). Chronic toxicities were similar: grade 1–2 pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and incontinence in 2 patients (11.8%). No patient experienced a grade ≥3 event. Conclusion Reirradiation using HDR-BT is well tolerated with low toxicity. An individualized multimodality approach using HDR-BT in the oligometastatic setting should be evaluated in prospective multi-institutional studies.

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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

Cited by 13 publications

References 27 publications

Long-Term Outcome of Centrally Located Hepatocellular Carcinomas Treated by Radical Resection Combined With Intraoperative Electron Radiotherapy (IOERT)

Long-Term Outcome of Centrally Located Hepatocellular Carcinomas Treated by Radical Resection Combined With Intraoperative Electron Radiotherapy (IOERT)

Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer

Outcome of intraoperative brachytherapy as a salvage treatment for locally recurrent rectal cancer

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