Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience

Chen, Allen M.; Bucci, M. Kara; Singer, Mark I.; García, Joaquín J.; Kaplan, Michael; Chan, Albert; Phillips, Theodore L.

doi:10.1016/j.ijrobp.2006.08.038

Cited by 41 publications

(50 citation statements)

References 36 publications

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“…More recently, Chen et al reported 1-, 2-, and 3-year rates of in-field control of 87%, 82%, and 82%, respectively, for patients with negative margins, compared with 65%, 53%, and 48%, respectively, for patients with positive margins. Positive microscopic margins were the only parameter predictive of in-field recurrence, although this did not translate into a difference in overall survival (8). In our series, 1-and 2-year in-field local progression-free survival was 80% vs. 55%, and 71% vs. 47% for negative and positive margins, respectively.…”

Section: Discussioncontrasting

confidence: 67%

“…In-field control was 70%, 64%, and 61% at 1, 2, and 3 years, respectively. Three-year overall survival was 36% (8). With regard to HDR-IORT, Nag et al reported on a series of 65 patients treated with this modality.…”

Section: Discussionmentioning

confidence: 99%

“…The role of brachytherapy as an adjunct to salvage surgery has yet to be clearly defined, however experiences with lowdose-rate (LDR) and high-dose-rate (HDR) interstitial modalities, and intraoperative radiation therapy (IORT), have yielded encouraging results (5)(6)(7)(8)(9). Advantages of IORT over interstitial brachytherapy include the ability to retract and shield normal surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

“…Local control rates range from 11% to 87% (9)(10)(11)(12)(13). Parameters predictive for the efficacy of IORT have been limited; however, margin status in the IORT field has been significantly linked to local control and overall survival with negative or close margins proving superior to positive margins (8,12). The reported surgical complication rates for salvage surgery in a previously irradiated field are already relatively high without the addition of IORT.…”

Section: Introductionmentioning

confidence: 99%

“…The reported surgical complication rates for salvage surgery in a previously irradiated field are already relatively high without the addition of IORT. Recent experience with IORT has not demonstrated a significant increase in complication rates above those observed from salvage surgery alone (8).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

High-Dose-Rate Intraoperative Radiation Therapy for Recurrent Head-and-Neck Cancer

Perry

Chan

Wolden

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

High-Dose-Rate Intraoperative Radiation Therapy for Recurrent Head-and-Neck Cancer

Perry

Chan

Wolden

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Commissioning, clinical implementation, and performance of the Mobetron 2000 for intraoperative radiation therapy

Wootton

Meyer

Kim

et al. 2017

J Applied Clin Med Phys

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The Mobetron is a mobile electron accelerator designed to deliver therapeutic radiation dose intraoperatively while diseased tissue is exposed. Experience with the Mobetron 1000 has been reported extensively. However, since the time of those publications a new model, the Mobetron 2000, has become commercially available. Experience commissioning this new model and 3 years of data from historical use are reported here. Descriptions of differences between the models are emphasized, both in physical form and in dosimetric characteristics. Results from commissioning measurements including output factors, air gap factors, percent depth doses (PDDs), and 2D dose profiles are reported. Output factors are found to have changed considerably in the new model, with factors as high as 1.7 being measured. An example lookup table of appropriate accessory/energy combinations for a given target dimension is presented, and the method used to generate it described. Results from 3 years of daily QA measurements are outlined. Finally, practical considerations garnered from 3 years of use are presented.

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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 for recurrent head-and-neck cancer: The UCSF experience

Cited by 41 publications

References 36 publications

High-Dose-Rate Intraoperative Radiation Therapy for Recurrent Head-and-Neck Cancer

High-Dose-Rate Intraoperative Radiation Therapy for Recurrent Head-and-Neck Cancer

Commissioning, clinical implementation, and performance of the Mobetron 2000 for intraoperative radiation therapy

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

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