IORT with Electrons as Boost Strategy during Breast Conserving Therapy in Limited Stage Breast Cancer: Results of an ISIORT Pooled Analysis

Sedlmayer, Felix; Fastner, Gerd; Merz, Florian; Deutschmann, H.; Reitsamer, Roland; Menzel, Christian; Ciabattoni, Antonella; Petrucci, A.; Hager, Eva; Willich, N.; Orecchia, Roberto; Valentini, Vincenzo

doi:10.1007/s00066-007-2013-6

Cited by 46 publications

(33 citation statements)

References 23 publications

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“…Consequently, our results showing complete equivalence between the planning parameters for all the users are promising. Slight deviations in the size of the applicator in one of the cases are fully consistent with differences in clinical practice between institutions, and are always 1 cm up or down (8).…”

Section: Discussionsupporting

confidence: 60%

“…However, these contributions have not yet been incorporated into IOERT because of the restrictions that surgical conditions enforce. The treatment planning system reported here overcomes part of these limitations, offering the Breast cancer is a main indication for IOERT, inasmuch as random studies (8,9) are being carried out to demonstrate the equivalence with external fractionated radiotherapy in breast conserving surgery. Consequently, our results showing complete equivalence between the planning parameters for all the users are promising.…”

Section: Discussionmentioning

confidence: 99%

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An Innovative Tool for Intraoperative Electron Beam Radiotherapy Simulation and Planning: Description and Initial Evaluation by Radiation Oncologists

Pascau

Miranda

Calvo

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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SummaryThe lack of specific treatment planning tools limits the spread of Intraoperative Electron Radiation Therapy. An innovative simulation and planning tool is presented. Applicator positioning, isodose curves, and dose volume histograms can be estimated for previously segmented regions to treat/protect. Evaluation by three radiation oncologists on 15 patients showed high parameter agreement in nine cases, demonstrating the possibilities in cases involving different anatomical locations, and Purpose: Intraoperative electron beam radiation therapy (IOERT) involves a modified strategy of conventional radiation therapy and surgery. The lack of specific planning tools limits the spread of this technique. The purpose of the present study is to describe a new simulation and planning tool and its initial evaluation by clinical users. Methods and Materials: The tool works on a preoperative computed tomography scan. A physi cian contours regions to be treated and protected and simulates applicator positioning, calcu lating isodoses and the corresponding doseevolume histograms depending on the selected electron energy. Three radiation oncologists evaluated data from 15 IOERT patients, including different tumor locations. Segmentation masks, applicator positions, and treatment parameters were compared. Results: High parameter agreement was found in the following cases: three breast and three rectal cancer, retroperitoneal sarcoma, and rectal and ovary monotopic recurrences. All radiation oncologists performed similar segmentations of tumors and high risk areas. The average appli cator position difference was 1.2 AE 0.95 cm. The remaining cancer sites showed higher devia tions because of differences in the criteria for segmenting high risk areas (one rectal, one pancreas) and different surgical access simulated (two rectal, one Ewing sarcoma). Conclusions:The results show that this new tool can be used to simulate IOERT cases involving different anatomic locations, and that preplanning has to be carried out with specialized surgical input.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

An Innovative Tool for Intraoperative Electron Beam Radiotherapy Simulation and Planning: Description and Initial Evaluation by Radiation Oncologists

Pascau

Miranda

Calvo

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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“…Au cours de la chirurgie d'exérèse partielle du cancer du sein (tumorectomie, quadrantectomie) une irradiation peropératoire permet de délivrer une dose soit unique, soit à titre de complément de dose préalable à une radiothérapie postopératoire. Plusieurs études rétrospectives et prospectives, (22,23,24,25) ont démontré la faisabilité de la technique, l'absence d'effets secondaires et son efficacité sur le contrôle local. Cette technique peut même être utilisée dans le cadre d'une chirurgie ambulatoire : tumorectomie ou quadrantectomie combinée à une irradiation per-opératoire unique, réalisée sans hospitalisation traditionnelle.…”

Section: -La Radiothérapie Intra-opératoireunclassified

New perspectives in radiation therapy

Dubois¹

2017

IJMS

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RESUMELes perspectives actuelles de la radiothérapie reposent à la fois sur de nouveaux concepts physiques, biologiques et sur des évolutions technologiques permanentes pour répondre à l'objectif fondamental de l'acte radiothérapique : traiter la tumeur, toute la tumeur et rien que la tumeur. Les progrès actuels et à venir concernent la précision dans la définition anatomique des volumes à traiter et des organes critiques à protéger avec l'introduction des techniques de l'imagerie dans la préparation et la réalisation du traitement au moyen de l'échographie, du PET Scan, et de l'imagerie sérielle embarquée (scanner, IRM) couplée à l'accélérateur linéaire. Les concepts modernes de la distribution de dose ont conduit au développement de la Radiothérapie tridimensionnelle de conformation et à une optimisation de la dosimétrie par les paradigmes nouveaux de la dosimétrie inverse permettant les applications de la modulation d'intensité, de la tomothérapie hélicoïdale, de la radiostéréotaxie pour des indications cliniques nouvelles auxquelles aucune thérapeutique alternative ne pouvait être proposée. Outre ces améliorations dans l'administration et la distribution de dose, la Radiothérapie se développe également dans d'autres modes de distribution : curiethérapie à débit pulsé, à haut débit de dose, ou avec implants permanents, radiothérapie intra-opératoire et aussi utilisation de rayonnements nouveaux : neutrons, protons, ions carbone. Des progrès sont également attendus avec le développement d'une évaluation biologique de la radiosensibilité des tissus tumoraux et de la radiotolérance des tissus sains permettant une adaptation permanente du fractionnement de la dose et de la dose délivrée tout au long du traitement. Enfin, des perspectives nouvelles apparaissent grâce à une meilleure conception du rôle de la radiothérapie et de sa place réelle dans le cadre d'une stratégie thérapeutique globale du cancer en fonction de chaque tumeur et de chaque patient. MOTS CLÉS :Radiothérapie de conformation -Dosimétrie inverse -Radiostéréotaxie -Curiethérapie à haut débit -Hadronthérapie. ABSTRACTNew developments and new technologies in radiation therapy are concerning the anatomical definition of the targets which are to be treated and of the critical organs which should be spared. These objectives can be reached by using modern imaging techniques: (US, PET Scan, CT Scan, MRI) allowing image-guided radiation Therapy (IGRT). Modern concepts of dose distribution (inverse dosimetry) lead to the tri-dimensional conformal Radiation Therapy (3D -CRT), intensity modulated Radiation Therapy (IMRT) and technological applications as helicoïdal tomotherapy, radiostereotaxy. New dose distribution techniques are also in progress: high dose rate (HDR), pulsed-dose-rate (PDR) brachytherapy, intraoperative Radiation Therapy and new medical applications of neutrons, protons, ions carbone. Moreover, improvements in radiation therapy administrations are expected by using biological investigations to know in real time tumor radiosensitization and...

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“…There is no consensus on the exact ideal population for the application of IORT in modern breast cancer treatment algorithms. IORT is stil considered as an experimental treatment protocol, and this technique is not performed in patients with serious co-morbidities or those with a history of previously performed RT, and it is limited to older patients with early stage breast cancer (35,36).…”

Section: Which Breast Cancer Patients Can Undergo Iort?mentioning

confidence: 99%

Intraoperative Period and Breast Cancer: Review

Akan

Simsek

2014

J Breasth Health

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Intraoperative radiation therapy in breast cancer (IORT) delivers a concentrated dose of radiation therapy to a tumor bed during surgery. IORT offers some of the following advantages with typically fewer complications like; maximum effect, sparing healthy tissues and organs, to help the patients finish treatment and get back to their normal activities. The goal of IORT is to improve local tumor control and survival rates for patients with breast cancer. IORT can both be performed with electron beams (ELIOT) and X-rays. Two main randomised trials testing intraoperative partial breast radiotherapy are TARGIT trial and the ELIOT (intraoperative radiotherapy with electrons) trial, but the techniques are fundamentally different. Whereas TARGIT delivers radiation from within the undisturbed tumour bed, for ELIOT, the mammary gland is mobilised, a prepectoral lead shield is inserted, the edges of the tumour bed are apposed, and radiation is delivered from without. Key words: Intraoperative period, breast cancer, treatment IntroductionCurrently, breast cancer is one of the leading causes of cancer in women. Nevertheless, there are rapid developments and changes in the diagnosis, treatment and follow-up methods of this disease. Today breast cancer can be diagnosed at earlier stages, with a chance for cure with limited surgery, and the patients have improved quality of life. Today, based on recent studies, the type of breast cancer surgery that led to complete loss of the breast has been replaced by breast-conserving surgery (BCS) in all appropriate patients (1-4). According to the results from large multicenter studies on early breast cancer, there were no significant differences in terms of disease-free survival and overall survival between mastectomy, and BCS and whole breast radiotherapy (RT). Therefore, conserving surgery and whole breast irradiation has been accepted as the standard treatment in early breast cancer, and it has been reported that local control also plays an important role on survival. One of the most feared clinical situations in the treatment of breast cancer, especially after BCS, is local recurrence (LR) at the site of operation. Undoubtedly, one of the most important ways to avoid this dreaded complication is application of RT to the tumor itself and around the tumor bed. Most of the LRs usually occur at the same quadrant with the tumor area that has been operated, due to the microscopic tumor remaining after BCS. A number of risk factors have been identified for the occurrence of LR, including large tumor size, high tumor grade, young patient age, lymph node involvement, and presence of tumor deposit close to surgical resection margin (5,6). There is a decrease in LR rates due to earlier diagnosis of breast cancer patients, high quality standards in pathological examinations, better individual treatment planning, and increased awareness on breast cancer. The focus of the discussion regarding the causes of LR and the developments leading to decreased LR rates is centered around mostly the...

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IORT with Electrons as Boost Strategy during Breast Conserving Therapy in Limited Stage Breast Cancer: Results of an ISIORT Pooled Analysis

Abstract: on behalf of the ISIORT Europe

Cited by 46 publications

References 23 publications

An Innovative Tool for Intraoperative Electron Beam Radiotherapy Simulation and Planning: Description and Initial Evaluation by Radiation Oncologists

An Innovative Tool for Intraoperative Electron Beam Radiotherapy Simulation and Planning: Description and Initial Evaluation by Radiation Oncologists

New perspectives in radiation therapy

Intraoperative Period and Breast Cancer: Review

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