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

Hilal, Lara; Feghali, Karine A. Al; Ramia, Paul; Gheida, Ibrahim Abu; Obeid, Jean‐Pierre; Jalbout, Wassim; Youssef, Bassem; Geara, Fady; Zeidan, Youssef H.

doi:10.3389/fonc.2017.00148

Cited by 5 publications

(11 citation statements)

References 40 publications

(112 reference statements)

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“…In this study, the RFS rate was found to improve significantly in the IOERT group as compared to the control group. This is in accordance with reports demonstrating the use of IOERT to improve RFS rates in patients with head and neck cancer and colorectal cancer (44,45). In the present study, no statistically significant difference was observed in the cumulative 3-year OS rates in the IOERT group verses control group.…”

Section: Discussionsupporting

confidence: 93%

The role of intraoperative electron radiotherapy in centrally located hepatocellular carcinomas treated with narrow-margin (<1 cm) hepatectomy: a prospective, phase 2 study

Wang¹,

Liu²,

Rong³

et al. 2022

Hepatobiliary Surg Nutr

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Background Postoperative radiotherapy (RT) is known to play an important role in the treatment of hepatocellular carcinomas (HCCs), but the specific role of intraoperative electron radiotherapy (IOERT) in HCCs remains unclear. The aim of this study was to investigate the safety and efficacy of IOERT in centrally located HCCs treated with narrow-margin (<1 cm) hepatectomy. Methods This was a single-center, phase 2, prospective non-randomized controlled study, including 268 patients with centrally located HCCs who underwent narrow-margin hepatectomy. The patients were subsequently allocated to the IOERT group (n=59) or to the control group (n=65). The primary outcome of the study was to compare recurrence-free survival (RFS) between the IOERT group and the control group, and the secondary outcome was to compare overall survival (OS) rate between the two groups. Results Of 268 patients enrolled, a total of 124 were included in the study: 59 in IOERT group, 65 in control group. The 1-, 2-, 3-year RFS rates were 79.3%, 62.1% and 45.8% for patients in the IOERT group, and 47.6%, 28.6%, and 22.9% for patients in the control group, respectively (P=0.025). The 1-, 2-, and 3-year OS rates were 100.0%, 94.9%, and 83.7% for patients in the IOERT group, and 92.3%, 87.5%, and 79.4% for patients in the control group, respectively (P=0.314). Subgroup analysis of MVI (+) patients revealed that RFS and OS are significantly prolonged in the IOERT subgroup as compared to the control, whereas there was no significant difference of RFS and OS between the two groups in MVI (−) patients. Conclusions IOERT for centrally located HCCs with concurrent narrow-margin hepatectomy was feasible and safe. Statistically better RFS rate was observed in the IOERT group compared to the control group. Subgroup analysis revealed that IOERT was more beneficial for postoperative survival of HCC patients with MVI. Trial Registration ChiCTR-TRC-12002802; www.who.int/ictrp .

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Section: Discussionsupporting

confidence: 93%

The role of intraoperative electron radiotherapy in centrally located hepatocellular carcinomas treated with narrow-margin (<1 cm) hepatectomy: a prospective, phase 2 study

Wang¹,

Liu²,

Rong³

et al. 2022

Hepatobiliary Surg Nutr

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“…Adverse events from reirradiation are a major concern, however, reirradiation may be recommended in situations where benefit outweighs risk (e.g., positive margins, perineural invasion, lymphovascular invasion, or extranodal extension), or if patients have unresectable, locally-recurrent HNC (15). Hilal et al included 15 retrospective studies in their review of IORT as a treatment for HNC, concluding that while IORT seems to be a promising treatment modality for HNC, most available literature remains from single institutions (5). IORT is considered in patients with HNC recurrences for its advantage of decreasing treatment volume to the site directly observed in the operating room and avoiding organs at risk.…”

Section: Discussionmentioning

confidence: 99%

“…Reirradiation with EBRT of local-regionally recurrent HNC comes with risk of treatment-related toxicity, including death (4). Alternatively, intraoperative radiation therapy (IORT) has been shown to improve outcomes from salvage surgery in patients who previously received EBRT; in the primary setting, IORT can be used as a boost to optimize local control (5).…”

Section: Introductionmentioning

confidence: 99%

“…IORT generally delivers a single dose of radiation at the time of resection of HNC (5). There are multiple modalities used for IORT, including orthovoltage photons, electrons (EIORT), and brachytherapy.…”

Section: Introductionmentioning

confidence: 99%

“…The IORT doses are typically higher than the doses delivered during individual fractions from EBRT, which reduces tumor cell survival but may also worsen treatment-related toxicity of normal tissue (5). However, the low energy x-ray beam generated with the INTRABEAM source provides a quick dose drop off which naturally limits the irradiation of critical structures in an IORT setting.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative radiation therapy for locally advanced and recurrent head and neck cancer

et al. 2022

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The purpose of the present study was to present a single institution experience with intraoperative radiation therapy (IORT) for patients with head and neck cancer (HNC). The present study included all patients with HNC treated consecutively with IORT at Loyola University Medical Center between January 2014 and December 2018. Charts were reviewed for patient and tumor characteristics, IORT technical details, IORT-induced adverse events and treatment outcomes. The study included 23 eligible patients. Median patient age was 66 years (range, 34-91 years). Tumor sites included the parotid gland (43%), lymph nodes (43%), oral tongue (9%) and ear (4%). A total of 48% of patients received IORT upfront with or without postoperative adjuvant external beam radiation therapy (EBRT), whereas 52% received salvage IORT after local tumor recurrence. The median prescribed IORT dose was 7.5 Gy (range, 5-14 Gy) in a single fraction prescribed to 5 mm depth with flat applicators (median diameter, 5 cm). A total of 92% of patients did not experience wound healing complications. One patient (4%) developed postoperative acute thromboembolic stroke and a second patient (4%) experienced protracted wound healing. At a median follow up of 36 months (range, 2-81 months), overall survival was 52%. In addition, 48% of patients were reported to have no evidence of disease, and although two had died of unrelated causes, 13% of patients were alive with disease and 39% died with the disease. The local-regional recurrence rate was 39% (median time to local recurrence, 11 months; range, 1-34 months), the rate of distant metastasis was 35% (median time to distant metastasis, 16 months; range, 4-40 months), and 21% of patients had both local-regional recurrence and distant metastases. The percentages of local-regional recurrence and distant metastases among patients receiving salvage IORT were 58 and 50% respectively, compared with 18 and 18% respectively in those receiving upfront IORT with or without adjuvant EBRT. In the present single institution retrospective study, it was concluded that IORT for patients with locally advanced and recurrent HNC was a safe treatment modality, with tumor control comparable to historical IORT data. Larger prospective studies are needed to further assess the utility of IORT in the management of locally advanced and recurrent HNC.

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Intraoperative radiation therapy with 50 kV x‐rays: A multi‐institutional review

Sethi,

Gros,

Brodin

et al. 2024

J Applied Clin Med Phys

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This report covers clinical implementation of a low kV intraoperative radiation therapy (IORT) program with the INTRABEAM® System (Carl Zeiss Meditec AG, Jena, Germany). Based on collective user experience from eight institutions, we discuss best methods of INTRABEAM quality assurance (QA) tests, commissioning measurements, clinical workflow, treatment planning, and potential avenues for research. The guide provides pertinent background information and clinical justification for IORT. It describes the INTRABEAM system and commissioning measurements along with a TG100 risk management analysis to ensure safety and accuracy of the IORT program. Following safety checks, dosimetry measurements are performed for verification of field flatness and symmetry, x‐ray output, and depth dose. Also discussed are dose linearity checks, beam isotropy, ion chamber measurements, calibration protocols, and in‐vivo dosimetry with optically stimulated luminescence dosimeters OSLDs, and radiochromic film. Emphasis is placed on the importance of routine QA procedures (daily, monthly, and annual) performed at regular intervals for a successful IORT program. For safe and accurate dose delivery, tests of important components of IORT clinical workflow are emphasized, such as, dose prescription, pre‐treatment QA, treatment setup, safety checks, radiation surveys, and independent checks of delivered dose. Challenges associated with in‐vivo dose measurements are discussed, along with special treatment procedures and shielding requirements. The importance of treatment planning in IORT is reviewed with reference to a Monte Carlo‐based commercial treatment planning system highlighting its main features and limitations. The report concludes with suggested topics for research including CT‐based image‐guided treatment planning and improved prescription dose accuracy. We hope that this multi‐institutional report will serve as a guidance document on the clinical implementation and use of INTRABEAM IORT.

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

Cited by 5 publications

References 40 publications

The role of intraoperative electron radiotherapy in centrally located hepatocellular carcinomas treated with narrow-margin (<1 cm) hepatectomy: a prospective, phase 2 study

The role of intraoperative electron radiotherapy in centrally located hepatocellular carcinomas treated with narrow-margin (<1 cm) hepatectomy: a prospective, phase 2 study

Intraoperative radiation therapy for locally advanced and recurrent head and neck cancer

Intraoperative radiation therapy with 50 kV x‐rays: A multi‐institutional review

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