Intraoperative irradiation: precision medicine for quality cancer control promotion

Calvo, Felipe A.

doi:10.1186/s13014-017-0764-5

Cited by 22 publications

(16 citation statements)

References 36 publications

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“…IOERT is a risk-adaptable technique in the era of personalized oncology [54]. New opportunities for systemic or regional therapy (intrahepatic and intraperitoneal), targeted therapies, vaccines and immunotherapy should be evaluated in an attempt to improve systemic disease control.…”

Section: Discussionmentioning

confidence: 99%

ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer

Asencio

Roeder

Krempien

et al. 2020

Clinical and Translational Radiation Oncology

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Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise RT modality to intensify the irradiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoradiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemotherapy followed by chemoradiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer.

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Section: Discussionmentioning

confidence: 99%

ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer

Asencio

Roeder

Krempien

et al. 2020

Clinical and Translational Radiation Oncology

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“…Intraoperative electron radiation therapy (IOERT) involves the delivery of a single-fraction, high-energy electron beam (4-20 MeV) to a post-resection tumour bed, which presents a high probability of harbouring residual cancer cells, or the macroscopic residue after partial resection [1]. The aim of IOERT is to promote local tumour control [2]. A specific applicator docked to a linear accelerator (LINAC) collimates the electron beam towards the treatment field.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative computed tomography imaging for dose calculation in intraoperative electron radiation therapy: Initial clinical observations

et al. 2020

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In intraoperative electron radiation therapy (IOERT) the energy of the electron beam is selected under the conventional assumption of water-equivalent tissues at the applicator end. However, the treatment field can deviate from the theoretic flat irradiation surface, thus altering dose profiles. This patient-based study explored the feasibility of acquiring intraoperative computed tomography (CT) studies for calculating three-dimensional dose distributions with two factors not included in the conventional assumption, namely the air gap from the applicator end to the irradiation surface and tissue heterogeneity. In addition, dose distributions under the conventional assumption and from preoperative CT studies (both also updated with intraoperative data) were calculated to explore whether there are other alternatives to intraoperative CT studies that can provide similar dose distributions. The IOERT protocol was modified to incorporate the acquisition of intraoperative CT studies before radiation delivery in six patients. Three studies were not valid to calculate dose distributions due to the presence of metal artefacts. For the remaining three cases, the average gamma pass rates between the doses calculated from intraoperative CT studies and those obtained assuming water-equivalent tissues or from preoperative CT studies were 73.4% and 74.0% respectively. The agreement increased when the air gap was included in the conventional assumption (98.1%) or in the preoperative CT images (98.4%). Therefore, this factor was the one mostly influencing the dose distributions of this study. Our experience has shown

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“…IORT is typically performed without image-based treatment planning. The current standard of care shows that delivering high doses of radiation precisely to the tumor bed with minimal exposure to the surrounding healthy tissues is possible with IORT based on the experience of the radiation oncologist, being guided by the surgery itself and his or her vision and touch [3,4]. The collaboration with biomedical engineering could benefit the technique by providing innovative solutions based on image-based approaches for preplanning, intraplanning, and documenting of the procedure [3,5].…”

Section: Introductionmentioning

confidence: 99%

A New Workflow for Image-Guided Intraoperative Electron Radiotherapy Using Projection-Based Pose Tracking

et al. 2020

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A new workflow is proposed to update the intraoperative electron radiotherapy (IOERT) planning refreshing the position and orientation (pose) of a virtual applicator with respect to the preoperative computed tomography (CT) with the actual pose during surgery. The workflow proposed relies on a robust registration of the preoperative CT and intraoperative projection radiographs acquired with a C-arm system. The workflow initially performs a geometric calibration of the C-arm using fiducials placed on the applicator. In the next step, a point-based 2D-3D registration based on fiducials positioned on the patient's skin is performed, followed by an intensity-based registration that refines the point-based registration result. The performance of the workflow has been evaluated using a realistic physical phantom consisting of a pig lower limb and its corresponding CT and 7 C-arm projections at different poses. The accuracy has been measured with respect to the applicator origin and axis before and after the registration refinement process. A feasibility study with human data is also included. Error analysis revealed angular accuracy of 0.9 ± 0.7 degrees and translational accuracy of 1.9 ± 1 mm. Our experiments demonstrated that the proposed workflow can achieve subdegree angular accuracy in locating the applicator with respect to the preoperative CT to update and supervise the IOERT planning right before radiation delivery. The proposed workflow could be easily implementable in a routine, corresponding to a significant improvement in quality assurance during IOERT procedures.

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Intraoperative irradiation: precision medicine for quality cancer control promotion

Cited by 22 publications

References 36 publications

ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer

ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer

Intraoperative computed tomography imaging for dose calculation in intraoperative electron radiation therapy: Initial clinical observations

A New Workflow for Image-Guided Intraoperative Electron Radiotherapy Using Projection-Based Pose Tracking

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