Intraoperative electron beam radiotherapy for locoregionally persistent or recurrent head and neck cancer

Abstract

Background: To report our institutional experience with intraoperative radiotherapy for persistent or recurrent head and neck cancer. Methods: Sixty-one patients were treated with salvage surgery and intraoperative radiation therapy (IORT). Fifty-eight patients (95%) had previously received external beam radiotherapy (EBRT) as a component of their definitive therapy. Fortyfour patients (72%) had squamous cell carcinoma (SCC). Surgical margins were positive in 28 patients (46%). IORT was prescribed to a median dose of 12.5 Gy (range, 10-17.5). Twenty-three patients (38%) received a course of postoperative EBRT (median 45 Gy). Clinical outcomes were retrospectively reviewed and univariate analysis was performed using log-rank tests to correlate clinical outcomes with histology, surgical margin, and adjuvant therapy. Results: Median follow-up among surviving patients was 15.9 months. Median progression-free survival (PFS) and overall survival (OS) were 9.8 and 19.1 months, respectively. One-and 2-year rates of locoregional control (LRC) were 59% and 35%, respectively. One-and 2-year rates of PFS were 39% and 19%, respectively. One-and 2-year rates of OS were 62% and 42%, respectively. Overall survival was better for non-SCC histology (P = .03). For SCC patients, negative surgical margin showed a trend toward improved PFS (P = .09) and OS (P = .06). There was one grade-5 toxicity due to carotid rupture. Conclusions: IORT has shown effective LRC and OS with an acceptably low rate of severe toxicity at our institution. OS was significantly better for non-SCC histology. For SCC patients, there is a trend toward improved PFS and OS associated with negative surgical margins. K E Y W O R D Shead and neck cancer, recurrence, salvage intraoperative radiotherapy

Exploring the Biochemical Foundations of a Successful GLUT1-Targeting Strategy to BNCT: Chemical Synthesis and In Vitro Evaluation of the Entire Positional Isomer Library of ortho-Carboranylmethyl-Bearing Glucoconjugates

“…7 Hz, H-6a), 4.07 (dd, 1H, H-4), 4.00 (dd, 1H, H-6b), 2.76 (d, 1H, 3-OH), 1.50 (s, 3H, 1,2-CH 3 ′), 1.45 (s, 3H, 5,6-CH 3 ′), 1.37 (s, 3H, 5,6-CH 3 ″), and 1.32 (s, 3H, 1,2-CH 3 ″) ppm. 13 C NMR (125.76 MHz, CDCl 3 , 23 °C): δ = 111.9 (1,2-q C), 109.8 (5,6-q C), 105.4 (C-1), 85.2 (C-2), 81.2 (C-4), 75.2 (C-3), 73.5 (C-5), 67.7 (C-6), 26.9 (1,2-CH 3 ′ and 5,6- 3.82 (dd, 1H, J 6a,5 = 2.3, J 6a,6b = −11.9 Hz, H-6a), 3.64 (dd, 1H, J 6b,5 = 5. 7 Hz, H-6b), 3.36 (dd, 1H, J 4,3 = 8.7 Hz, J 4,5 = 9.8 Hz, H-4), 3.24 (ddd, 1H, H-5), 3.18 (dd, 1H, J 3,2 = 9.0 Hz, H-3), 3.17 (dd, 1H, H-2), and 3.05−1.42 (br m, 10H, carborane−BH) ppm.…”

“…for C37H48B10O6K [M + K] + 737.4018; found 737.4057. (3). Synthesized from Benzyl 3,4,6-tri-O-benzyl-2-O-carboranylmethyl-β-Dglucopyranoside (0.11 g, 0.2 mmol) and 10% Pd/C (0.11 g, 1.0 mmol) according to the general procedure for hydrogenolysis.…”

“…1,2 While a combination of surgery and chemotherapy remains the primary method for treatment of these cancers, the conventional therapies face significant challenges as the percentage of inoperable and recurrent cancers in this category (20-40%) is exceptionally high. 2,3 In these cases, there is a clear need for novel and improved treatment options. Among the existing treatment possibilities available Boron Neutron Capture Therapy (BNCT) stands out as one of the most promising alternatives.…”

“…Despite the continuous progress made in radio- and chemotherapies, there are still a vast number of patients with untreatable as well as recurring cancers. Head and neck cancers account for 10% of all cancers with 630,000 new cases diagnosed annually on a global scale. , While a combination of surgery and chemotherapy remains the primary method for treatment of these cancers, the conventional therapies face significant challenges as the percentage of inoperable and recurrent cancers in this category (20–40%) is exceptionally high. , In these cases, there is a clear need for novel and improved treatment options. Among the existing treatment possibilities available, boron neutron capture therapy (BNCT) stands out as one of the most promising alternatives …”

2D-3D Image Registration for Image Guided Intraoperative Radiotherapy

“…Another complication that might occur after IOERT is carotid artery blow which can _________________________________________________________________________ be avoided by shielding or moving out the major vessels and nerves from the treatment field (Pinheiro et al 2003). Otherwise, IOERT is relatively safe, promotes local control, and decreases the dose of postoperative EBRT required (Wald et al 2019).…”