Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

Abstract

The purpose of this study is to evaluate the efficacy of intraoperative radiation therapy (IORT) and the problem of securing the IORT field in advanced pediatric neuroblastoma. Between 1996 and 2005, 12 children received IORT for advanced pediatric neuroblastoma patients. Electron beam energies ranged from 10 to 12 MeV and median dose was 10 Gy (8-12 Gy). All of them had surgery with IORT against the primary tumor site and the abdominal aorta surroundings. A gross total resection (GTR) was achieved in 10 patients and subtotal resection (STR) was two patients. All of 12 patients were classified as high risk. Nine patients were alive 17-120 (mean 48 months) after diagnosis. Local tumor control was achieved in 100% of patients, of whom one experienced local recurrence outside the IORT field. At the operation, it was difficult to secure the IORT field because of the angle of the radiation cylinder in three patients. One of the three of these patients experienced local recurrence outside of the IORT field in the upper side of superior mesenteric artery and two of three patients had an external beam radiation after surgery, and there was no local recurrence. One patient had a postoperative ileus, and one patient had transient diarrhea and hydronephrosis. For advanced neuroblastoma patients, IORT produced excellent local control after surgery. However, there is a problem of securing the IORT field. For local control, it is necessary to add an external beam radiation after IORT when it is difficult to secure the IORT field.

2017 GPOH Guidelines for Diagnosis and Treatment of Patients with Neuroblastic Tumors

“…Hence, EBRT appears to compensate the negative effect of postoperative residual tumor on outcome, in line with the results published by Robbins et al [160]. Intra-operative radiotherapy was found to be effective in a small series, but was associated with a considerable frequency of late effects, such as vascular stenosis [64,138,192]. Taken together, published data support the current GPOH strategy of recommending EBRT following myeloablative chemotherapy and ASCT for cases where unresectable vital residual tumor tissue is present after surgery and induction therapy.…”

Application of high-dose rate 60Co remote after loading system for local recurrent neuroblastoma

“…Curative treatment of relapsed or resistant NB has not yet been established. We have confirmed that adjuvant radiotherapy has proven effective and is an important modality for local control in high-risk NB [1]. Here, we report a case in which HDR-60Co-RALS treatment is used for postoperative intraabdominal irradiation for local recurrence of NB between the right upper retroperitoneum and backside of the right hepatic lobe and discuss the efficacy of this modality.…”

“…Some investigators have attributed complications including episodes of gastrointestinal bleeding, gastrointestinal obstruction, colitis, hydronephrosis, neuropathy, scoliosis, increased infection, secondary neoplasms, and arterial stenosis to the use of IORT and EBRT [1,[11][12][13][14][15][16]. Although we were concerned about the possible complications of HDR-RALS treatment to organs surrounding the applicators, such as the gastrointestinal tract, pancreas, liver, bile duct, abdominal nerves, and major vessels, there were no complications observed during the early postoperative period.…”

“…External beam radiation therapy also has been described as effective in cases of advanced NB [6][7][8]. The importance of intensive local treatment of advanced NB was emphasized in other studies [1,[9][10][11]. The RALS treatment provides brachytherapy using the source of HDR and is a method to deliver the source into a patient's body by remote control.…”

Intraoperative radiation therapy opportunities for clinical practice normalization: Data recording and innovative development

“…The applicator size was variable but 5 cm applicators were used in more than half of the cases. 18 In the last decades, clinical indications to IORT treatment have evolved significantly and expert centres incorporated this technique to the treatment of breast cancer. As the results show, the incorporation of breast cancer in this treatment modality is relatively late, but in the last 2 years the number of treatments performed became the third in terms of frequency.…”