Intraoperative high‐dose‐rate radiotherapy in the management of locoregionally recurrent head and neck cancer

Scala, L.M.; Hu, Kenneth; Urken, Mark L.; Jacobson, Adam S.; Persky, Mark S.; Tran, Theresa; Smith, Mark L.; Schantz, Stimson P.; Harrison, Louis B.

doi:10.1002/hed.23007

Cited by 32 publications

(33 citation statements)

References 18 publications

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“…Scala et al reported that 1-year in-field control for patients with negative margins was 82% compared to 56% in those with a positive margin (9). At least five other studies also showed that positive margins (more so for gross residual than microscopic residual) at the time of IORT significantly predicted for in-field failure when compared to close or clear margins (2, 11, 13, 18, 19).…”

Section: Role Of Iort In Head and Neck Tumorsmentioning

confidence: 99%

“…In addition, doses of IORT of more than 15 Gy were shown to be associated with better LC (10, 12). Other prognostic factors for LC and RFS include pre-reirradiation recurrence-free interval of more than 12 months (10), use of adjuvant EBRT (9), absence of nodal extra-capsular extension (10), and tumor size (11). Furthermore, patients with neck metastasis who had no PNI, no LVSI, and no involvement of the carotid artery were reported to have better OS after IORT (12).…”

Section: Role Of Iort In Head and Neck Tumorsmentioning

confidence: 99%

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Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

et al. 2017

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Every year, almost 62,000 are diagnosed with a head and neck cancer (HNC) and 13,000 will succumb to their disease. In the primary setting, intraoperative radiation therapy (IORT) can be used as a boost in select patients in order to optimize local control. Addition of external beam radiation to limited volumes results in improved disease control over surgery and IORT alone. In the recurrent setting, IORT can improve outcomes from salvage surgery especially in patients previously treated with external beam radiation. The use of IORT remains limited to select institutions with various modalities being currently employed including orthovoltage, electrons, and high-dose rate brachytherapy. Practically, execution of IORT requires a coordinated effort and careful planning by a multidisciplinary team involving the head and neck surgeon, radiation oncologist, and physicist. The current review summarizes common uses, outcomes, toxicities, and technical aspects of IORT in HNC patients.

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Section: Role Of Iort In Head and Neck Tumorsmentioning

confidence: 99%

Section: Role Of Iort In Head and Neck Tumorsmentioning

confidence: 99%

Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

et al. 2017

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“…Resection status at salvage was the most important factor determining local control [17, 19, 21]. Microscopically residual tumours did better with IORT [23], gross residual disease however did not [20, 23]. Adjuvant EBRT after IORT appears to further improve local control, however the small sample size of these studies precludes any definite conclusions [20, 23].…”

Section: Clinical Results With Iortmentioning

confidence: 99%

“…Microscopically residual tumours did better with IORT [23], gross residual disease however did not [20, 23]. Adjuvant EBRT after IORT appears to further improve local control, however the small sample size of these studies precludes any definite conclusions [20, 23]. Wound complications, osteoradionecrosis (ORN), fistulae, and neuropathy are the most common complications [17–22] after IOERT; however, these are rare with doses less than 20 Gy [22] and no different than that of re-irradiation with EBRT [16].…”

Section: Clinical Results With Iortmentioning

confidence: 99%

Intraoperative radiotherapy: review of techniques and results

Pilar¹,

Gupta²,

Laskar³

et al. 2017

ecancer

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Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community.Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise.IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers).This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.

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“…The third reason is that with better imaging, we can detect more local and regional recurrences when they are smaller and more amenable to either surgery or radiotherapy (RT). Finally, intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic body radiosurgery (SBRS), tomotherapy, improved brachytherapy and protons technology allow us to deliver rRT with increased precision and hence, better patient tolerability [6,7].…”

mentioning

confidence: 99%

When is re-irradiation in head and neck squamous cell carcinoma not indicated?

Strojan

Beitler

Silver

et al. 2013

Eur Arch Otorhinolaryngol

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Intraoperative high‐dose‐rate radiotherapy in the management of locoregionally recurrent head and neck cancer

Abstract: HDR-IORT is well tolerated and associated with encouraging in-field disease control. In-field control is associated with improved survival. Further study is warranted to more fully investigate HDR-IORT in the salvage setting.

Cited by 32 publications

References 18 publications

Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

Intraoperative radiotherapy: review of techniques and results

When is re-irradiation in head and neck squamous cell carcinoma not indicated?

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