Interventional Oncology: Should Interventional Radiotherapy (Brachytherapy) be Integrated into Modern Treatment Procedures?

Abstract

The delivery of a very high dose by radiotherapy to a dedicated target with minimal surrounding normal tissue dose is a challenging situation. From a radiotherapy point of view, in several anatomic situations, the most optimal method is the use of interventional radiotherapy (brachytherapy; IRT) alone or in combination with other established interventional tumor cell eliminating methods. METHODS First, Interventional Radiotherapy, Interventional Radiology, Interventional Endoscopy and Interventional Chemotherapy have the same aim of eliminating tumor tissue. Second, target definition and some IRT application techniques need multidisciplinary teamwork. RESULTS Multidisciplinary teams have the best potential to offer the best possible cure in localized solid tumors or in selected oligometastatic disease. Examples for this kind of service are given for H&N-, anal-, vaginal-, breast-, prostate cancers as well as in oligometastatic disease. The combined use of interventional tumor ablation techniques is demonstrated. CONCLUSION Interventional Oncology has the potential to improve the treatment results in localized solid cancers or in selected oligometastatic disease, and large workload Interventional Oncology Centers could have an important role in the patient service, in the education as well as in the clinical research.

Use of electrochemotherapy in a combined surgical treatment of local recurrence of rectal cancer

“…The ECT allows to perform surgery on a perianal district not subjected to neoadjuvant radiotherapy, with a lower risk of local infectious complications that often significantly impair the quality of life of the patients. This clinical case also confirms the importance of discussing cases in multidisciplinary meetings [ 6 , 7 ].…”

The role of vaginal brachytherapy in stage I endometrial serous cancer: a systematic review

“…Nevertheless, it is important that in no experienced centers, VBT can result in crucial side effects [52]. Considering the rarity of this disease, every case of stage I USC should be discussed with individual approach by an expert multidisciplinary team to provide more homogeneous treatment methods and improvement of clinical outcomes [53,54,55].…”

INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy) endorsed by AIRO (Italian Association of Radiotherapy and Clinical Oncology)

“…Adjuvant and neoadjuvant EBRT are comparable in terms of efficacy, with the latter associated with higher rate of acute toxicity and wound complications, but lower incidence of late toxicities and a potential of tumor downsizing when required for increasing the outcomes of subsequent limb-sparing surgery [ 30 , 31 ]. Different RT techniques, such as IRT or IORT, could be used with less toxicity and similar outcomes to EBRT, but they are performed in very few centers with an expertise in the field, especially in STS [ 32 , 33 , 34 , 35 , 36 ].…”

“…Despite the data from the literature, the contribution of IRT (and generally of interventional oncology) to treat STS patients is not clearly defined [ 15 , 35 ].…”