In vivo dosimetry in cancer patients undergoing intraoperative radiation therapy

Abstract

In vivo dosimetry (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.

Cost-effectiveness of tumor-treating fields plus standard therapy for advanced non-small cell lung cancer progressed after platinum-based therapy in the United States

“…Tumor treating fields (TTF) is a non-invasive tumor physical therapy, demonstrating significant therapeutic efficacy, convenience, and minimal adverse reactions in recurrent glioblastoma ( Kirson et al, 2004 ). Further, the National Comprehensive Cancer Network (NCCN) recommended TTF for treating recurrent and newly diagnosed glioblastoma in 2013 and 2016, respectively ( Petoukhova et al, 2023 ; Swartz et al, 2023 ). Preclinical research focusing on NSCLC suggests that TTF induces immunogenic death of tumor cell, enhances antigen presentation of dendritic cells and leukocyte chemotaxis, and synergizes with PD-1/PD-L1 inhibitors to inhibit tumor growth ( Giladi et al, 2014 ; Giladi et al, 2015 ; Karanam et al, 2017 ; Shteingauz et al, 2018 ; Voloshin et al, 2020 ).…”