A prospective phase I comparison of toxicity and cosmesis outcomes of single-fraction IORT and hypofractionated radiotherapy with IORT boost in early-stage breast cancer

Bhandari, Tanuja; Babaran, Wesley; Forouzannia, Afshin; Williams, Venita; Harness, Jay K.; Carpenter, Marco D.; Gobran, Maher; Khanijou, Rajesh; Wagman, Brittany; Ash, Robert B.; Wagman, Lawrence D.

doi:10.1016/j.brachy.2017.09.002

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…In the study by Bhandari et al only 24 patients underwent IOERT as a boost; after a short follow-up (12 months), G1 and G2 acute toxicity was present in 47.8% and 4.4% of the cases, respectively; late toxicity in 40% (G1) and in 10% (G2) of the cases. 28 In the recent paper from HIOB prospective multicenter trial, G0−1 acute effects were noted in 92% of patients and G3 in one patient, 4 weeks after the end of WBRT; G0−1 late toxicity in 93%, G2 in 4.3% and G3−4 in 2.7% of cases at 4 years. 14 Our results are similar to the data reported in the other series and even better than the results of the early published reports.…”

Section: Discussionmentioning

confidence: 97%

State of the art in breast intraoperative electron radiation therapy after intraoperative ultrasound introduction

Vidali

Severgnini

Giudici

et al. 2021

Radiology and Oncology

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Background Breast intraoperative electron radiation therapy (B-IOERT) can be used in clinical practice both as elective irradiation (partial breast irradiation – APBI) in low risk breast cancer patients, and as an anticipated boost. The procedure generally includes the use of a shielding disk between the residual breast and the pectoralis fascia for the protection of the tissues underneath the target volume. The aim of the study was to evaluate the role of intraoperative ultrasound (IOUS) in improving the quality of B-IOERT. Patients and methods B-IOERT was introduced in Trieste in 2012 and its technique was improved in 2014 with IOUS. Both, needle and IOUS were used to measure target thickness and the latter was used even to check the correct position of the shielding disk. The primary endpoint of the study was the evaluation of the effectiveness of IOUS in reducing the risk of a disk misalignment related to B-IOERT and the secondary endpoint was the analysis of acute and late toxicity, by comparing two groups of patients treated with IOERT as a boost, either measured with IOUS and needle (Group 1) or with needle alone (Group 2). Acute and late toxicity were evaluated by validated scoring systems. Results From the institutional patients who were treated between June 2012 and October 2019, 109 were eligible for this study (corresponding to 110 cases, as one patients underwent bilateral conservative surgery and bilateral B-IOERT). Of these, 38 were allocated to group 1 and 72 to group 2. The target thickness measured with the IOUS probe and with the needle were similar (mean difference of 0.1 mm, p = 0.38). The percentage of patients in which the shield was perfectly aligned after IOUS introduction increased from 23% to more than 70%. Moreover, patients treated after IOUS guidance had less acute toxicity (36.8% vs. 48.6%, p = 0.33) from radiation therapy, which reached no statistical significance. Late toxicity turned out to be similar regardless of the use of IOUS guidance: 39.5% vs. 37.5% (p = 0.99). Conclusions IOUS showed to be accurate in measuring the target depth and decrease the misalignment between collimator and disk. Furthermore there was an absolute decrease in acute toxicity, even though not statistically significant, in the group of women who underwent B-IOERT with IOUS guidance.

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Section: Discussionmentioning

confidence: 97%

State of the art in breast intraoperative electron radiation therapy after intraoperative ultrasound introduction

Vidali

Severgnini

Giudici

et al. 2021

Radiology and Oncology

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“…The most important dosimetric feature of an electron beam is its limited range, which can effectively avoid irradiation of organs behind the tumor target. In addition, it is used in IORT for head and neck ( 28 ), abdominal ( 29 , 30 ), breast ( 31 , 32 ), and sarcoma ( 33 ) tumors.…”

Section: Methodsmentioning

confidence: 99%

Delivery of intensity-modulated electron therapy by mechanical scanning: An algorithm study

Tian

et al. 2022

Front. Oncol.

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PurposeIn principle, intensity-modulated electron therapy (IMET) can be delivered through mechanical scanning, with a robotic arm mounting a linac.Materials and methodsHere is a scanning algorithm to identify the back-and-forth, top-to-bottom (zigzag) pattern scan sequence. The algorithm includes generating beam positions with a uniform resolution according to the applicator size; adopting discrete energies to achieve the depth of 90% dose by compositing energies; selecting energy by locating the target’s distal edge; and employing the energy-by-energy scan strategy for step-and-shoot discrete scanning. After a zigzag scan sequence is obtained, the delivery order of the scan spots is optimized by fast simulated annealing (FSA) to minimize the path length. For algorithm evaluation, scan sequences were generated using the computed tomography data of 10 patients with pancreatic cancer undergoing intraoperative radiotherapy, and the results were compared between the zigzag path and an optimized path. A simple calculation of the treatment delivery time, which comprises the irradiation time, the total robotic arm moving time, the time for energy switch, and the time to stop and restart the beam, was also made.ResultsIn these clinical cases, FSA optimization shortened the path lengths by 12%–43%. Assuming the prescribed dose was 15 Gy, machine dose rate was 15 Gy/s, energy switch time was 2 s, stop and restart beam time was 20 ms, and robotic arm move speed was 50 mm/s, the average delivery time was 124±38 s. The largest reduction in path length yielded an approximately 10% reduction in the delivery time, which can be further reduced by increasing the machine dose rate and the robotic arm speed, decreasing the time for energy switch, and/or developing more efficient algorithms.ConclusionMechanically scanning IMET is potentially feasible and worthy of further exploration.

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“…105 Similar outcomes have been seen in other series, with favorable QOL outcomes reported with IORT. [129][130][131][132][133][134][135] Multiple clinical guidelines were identified that evaluated IORT and its role in the management of early stage breast cancer. Though published before the ELIOT and TARGIT-A updates, current guidelines from the American Society for Radiation Oncology (ASTRO) and American Brachytherapy Society (ABS) do not recommend IORT outside of prospective studies, with the exception of the ASTRO guidelines allowing for electron IORT in suitable-risk patients.…”

Section: Ultrashort Partial Breast Irradiationmentioning

confidence: 99%

Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review

Vicini

Broughman

Halima

et al. 2022

International Journal of Radiation Oncology*Biology*Physics

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A prospective phase I comparison of toxicity and cosmesis outcomes of single-fraction IORT and hypofractionated radiotherapy with IORT boost in early-stage breast cancer

Cited by 7 publications

References 19 publications

State of the art in breast intraoperative electron radiation therapy after intraoperative ultrasound introduction

State of the art in breast intraoperative electron radiation therapy after intraoperative ultrasound introduction

Delivery of intensity-modulated electron therapy by mechanical scanning: An algorithm study

Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review

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