Japan gastric trials in intraoperative radiation therapy

Abe, Mitsuyuki; Takahashi, Masaji; Ono, Kouichi; Tobe, T; Inamoto, Takashi

doi:10.1016/0360-3016(88)90239-8

Cited by 54 publications

(11 citation statements)

References 5 publications

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“…IOERT might indirectly improve the quality of therapy, as a secondary endpoint, by decreasing the overall treatment time [19]. This increase in the therapeutic ratio may also translate into survival benefit, especially in cancer sites with high risk of isolated loco-regional relapse [1]. The contribution of local control to survival in patients with extremity STS is controversial [17,20].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Azinovic¹,

Monge²,

Aristu³

et al. 2003

Radiotherapy and Oncology

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Purpose: To analyze the patterns offailure and the toxicity profile of intraoperative electron beam radiotherapy (IOERT) after resection of soft tissue sarcomas of the extremities (STS). Patients and methods: Forty-five patients with extremity STS were treated with IOERT and moderate-dose postoperative radiotherapy (45-50 Gy). Twenty-six patients were treated for primary disease (PD) and 19 patients for an isolated recurrence (ILR). Tumor size was > 5 cm (maximum diameter) in 36 patients (80%), and high-grade histology in PD patients was present in 14 patients (54%). In nine patients, IOERT was used alone, due to previous irradiation or patient refusal. Chemotherapy (neoadjuvant and/or adjuvant) was mainly given to high-grade tumors. Results: Nine patients relapsed in the extremity (20%), and 12 patients in distant sites (28%). Actuarial local control at 5 years was 88% for patients with negative/close margins and 57% for patients presenting positive margins (P = 0.04). Five patients (11%) developed neuropathy associated with the treatment. Extremity preservation was achieved in 40 patients (88%). With a median follow-up of 93 months (range: 27-143 months) for the patients at risk, 25 patients remain alive (a 7-year actuarial survival rate of 75% for PD and 47% for ILR; P = 0.01). Conclusions: IOERT combined with moderate doses of external beam irradiation yields high local control and extremity preservation rates in resected extremity STS. Peripheral nerves in the IOERT field are dose-limiting structures requiring a dose compromise in the IOERT component to avoid severe neurological damage.

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Section: Discussionmentioning

confidence: 99%

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Azinovic¹,

Monge²,

Aristu³

et al. 2003

Radiotherapy and Oncology

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“…IORT has been successfully used in the treatment of gastric cancer patients (1,3). External beam radiotherapy techniques for post-gastrectomy patients have been refined in the last decade (31).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative and external radiotherapy in resected gastric cancer: Updated report of a phase II trial

Calvo¹,

Aristu²,

Azinovic³

et al. 1992

International Journal of Radiation Oncology*Biology*Physics

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From September 1984 to August 1991, 48 evaluable patients with resected gastric cancer and apparent disease confined to locoregional area were treated with intraoperative electron beam boost to the celiac axis and peripancreatic nodal areas (15 Gy) and external irradiation (40 to 46 Gy in 4 to 5 weeks ) including the gastric bed and upper abdominal nodal draining regions. At the time of evaluation for IORT, the disease was primary in 38 cases, recurrent but resectable in four (anastomosis), and unresectable in four (nodal). Post operative complications were reversible. Acute tolerance to the complete treatment program was acceptable. Late complications included lifethreatening events: Six episodes of gastro intestinal bleeding (three of them had an arteriographic documentation of arterioenteric fistula) and nine with severe enteritis (five required reoperation). Other long-term treatment related complications were six cases of vertebral collapse. The median follow-up time for the entire group is 22 months. Locoregional recurrence / persistence of disease has been identified in five patients (three with residual and /or recurrent postsurgical tumor). Systemic tumor progression has been detected in 15 patients (11 in intra-abdominal sites). Overall actuarial survival for patients with positive or negative serosal involvement was 33% versus 56%. It is concluded that the treatment program described is able to induce a high locoregional tumor control rate (100%) when used strictly in an adjuvant setting and might control long term, a small portion of patients not amenable for curative surgery (2 out of 8 patients with confirmed residual post-surgical disease). Gastrointestinal bleeding and enteritis are findings that indicate treatment intensity at the upper limits of tissue tolerance. Assessment of long term tolerance of pancreatic parenchima and large blood vessels (tissues included in the IRORT field) are pending for longer follow-up and the appropriate selective studies.

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“…Abe (1988) has pioneered the use of intraoperative radiation therapy to decrease the incidence of local and regional failure. He recommends that intraoperative radiation therapy be used only after surgical removal of the primary tumour in patients: (1) with no metastases tb the liver or peritoneum; (2) with serosal invasion limited to the posterior wall of the stomach: and (3) where all unresectable lesions can be encompassed by a single radiation field.…”

Section: Technical Considerations Of Operations For Gastric Cancermentioning

confidence: 99%

Gastric cancer—surgical approach

Weese

Nussbaum

1992

Hematological Oncology

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Although the incidence of carcinoma of the stomach has steadily declined over the last 50 years, approximately 23,000 new cases will be diagnosed in the United States this year and 13,700 patients will die. Despite marked improvement in operative techniques, fewer than 20 per cent of those diagnosed with gastric cancer beyond the most superficial levels of invasion will survive for over five years. Gastric tumours spread by local, lymphatic, and aggressive intra-peritoneal routes as well as hematogenous dissemination. Over 87 per cent of recurrences have local or regional components. Radiation therapy may decrease local and regional recurrences in those patients with transmural tumours. The neoadjuvant use of etoposide, adriamycin, and platinum may yield complete clinical and pathologic responses in patients found to have 'unresectable' tumours. Other chemotherapy regimens have been shown to have some effect on advanced disease and may have a role in the neoadjuvant setting. Our current recommendations for the treatment of gastric cancer in a controlled trial setting would be neoadjuvant chemotherapy followed by R2 resection, postoperative +/- intraoperative radiation therapy with the possibility of postoperative chemotherapy. Hopefully, this aggressive multimodality approach will significantly improve the five year survival for this disease.

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Japan gastric trials in intraoperative radiation therapy

Cited by 54 publications

References 5 publications

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Intraoperative and external radiotherapy in resected gastric cancer: Updated report of a phase II trial

Gastric cancer—surgical approach

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