The American Brachytherapy Society consensus statement on intraoperative radiation therapy

Tom, Martin C.; Joshi, Nikhil; Vicini, Frank A.; Chang, Albert; Hong, Theodore S.; Showalter, Timothy N.; Chao, Samuel T.; Wolden, Suzanne L.; Wu, Abraham J.; Martin, Douglas D.; Husain, Zain; Badiyan, Shahed N.; Kolar, M.; Sherertz, Tracy; Mourtada, Firas; Cohen, Gil’ad N.; Shah, Chirag

doi:10.1016/j.brachy.2019.01.015

Cited by 57 publications

(35 citation statements)

References 144 publications

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“…Electron IORT was recommended to be restricted to patients with “suitable risk” disease . Similarly, the American Brachytherapy Society IORT consensus statement recommends breast IORT be performed on prospective studies …”

Section: Discussionmentioning

confidence: 99%

“…However, it is important to recognize that substantial differences exist with IORT compared with other PBI techniques such as interstitial brachytherapy, applicator brachytherapy, and external beam partial breast irradiation . Additionally, it is important to recognize that multiple IORT techniques exist including intraoperative electron radiation therapy (IOERT), low‐energy IORT, and more recently high‐dose brachytherapy (HDR‐IORT), which each have different properties with respect to prescription dose and dose at depth . A prospective randomized trial (TARGIT‐A) from Vaidya et al compared outcomes with low‐energy IORT and WBI.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Additionally, it is important to recognize that multiple IORT techniques exist including intraoperative electron radiation therapy (IOERT), low-energy IORT, and more recently high-dose brachytherapy (HDR-IORT), which each have different properties with respect to prescription dose and dose at depth. 4 A prospective randomized trial (TARGIT-A) from Vaidya et al compared outcomes with low-energy IORT and WBI. The trial allowed IORT monotherapy for patients with T1-2 tumors, pathologically negative margins, and no axillary nodal metastasis.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes with intraoperative radiation therapy for early‐stage breast cancer

et al. 2020

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Adjuvant radiation therapy has been associated with improved local control following breast‐conserving surgery. Traditionally, treatment has been delivered with whole breast irradiation over 3‐6 weeks or partial breast irradiation over 1‐3 weeks. However, intraoperative radiation therapy (IORT) has emerged as a technique that delivers a single dose of radiotherapy at the time of surgery for early‐stage breast cancers. We report initial outcomes and acute toxicities with intraoperative radiation from a single institution. Patients with DCIS or Stage I‐II breast cancer who underwent lumpectomy and sentinel lymph node biopsy (nodal sampling excluded in some cases) were included. All patients in this analysis were treated with IORT as at the time of surgery, 20 Gy in 1 fraction with 50 kV x‐ray. Patients were treated at a single institution between 2011 and 2019. Follow‐up was per standard institutional protocol. Two hundred and one patients were included in the analysis, with a median follow‐up of 23 months (range: 0‐73 months). Median age was 71 years old. Overall, 4 (2.0%) patients had DCIS, 186 (92.5%) patients had Stage 1 disease, and 11 patients had (5.5%) Stage 2 disease. All patients were estrogen receptor‐positive, 175 (87.9%) progesterone receptor‐positive, and 1 (0.5%) HER2 amplified. The crude rate of local recurrence was 2.0% (n = 4) and distant metastasis rate was 0.5% (n = 1). The rate of arm lymphedema was 0.5% (n = 1) and chronic telangiectasia rate was 1.1% (n = 2). Intraoperative radiation therapy, in a cohort of low‐risk patients, demonstrated low rates of recurrence and reproducibility in a multi‐disciplinary setting. Further follow‐up, analysis of patient satisfaction and cosmesis, and comparison to whole breast irradiation and partial breast techniques is necessary in order to further validate these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes with intraoperative radiation therapy for early‐stage breast cancer

et al. 2020

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“…Aside from their high efficacy driven by the use of large single doses, IORT or brachytherapy boosts usually result in much smaller irradiated volumes compared to external-beam boosts, which seems to allow dose escalation without an increase in functional deficits by late side effects. Detailed descriptions of each technique including summarized results of the published series are beyond the scope of the current work but have recently been reviewed in [21,22]. Postoperative brachytherapy has been used also as a sole form of adjuvant radiation therapy based on the randomized trial by Pisters et al [23] from the early 1990s, which showed improved local control rates compared to surgery alone.…”

Section: Perioperative Rt In Extremity/trunk Sarcomasmentioning

confidence: 99%

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Roeder

2020

Cancers

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Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. Modern radiation techniques, like intensity-modulated, image-guided, or stereotactic body RT, as well as special applications like intraoperative RT, brachytherapy, or particle therapy, have widened the therapeutic window allowing either dose escalation with improved efficacy or reduction of side effects with improved functional outcome. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment, namely its use as an adjunct to surgery in resectable STS (perioperative RT), as a primary treatment in non-resectable tumors (definitive RT), as a local treatment modality in oligometastatic disease or as palliative therapy. Due to the known differences in clinical course, general treatment options and, consequently, outcome depending on lesion localization, the main part of perioperative RT is divided into three sections according to body site (extremity/trunk wall, retroperitoneal, and head and neck STS) including the discussion of special applications of radiation techniques specifically amenable to this region. The review of the current evidence is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS.

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“…Brady et al have reported that IORT may be utilized as a tool to improve local control in patients with locally advanced primary or recurrent colorectal cancer [7]. However, there were limited previous studies of IORT for primary colon cancer and most of the patients in these researches received either IOERT or high-dose-rate intraoperative brachytherapy [8,9] with only a few studies describing outcomes for colorectal cancer patients using orthovoltage IORT [10][11][12]. At present, electronic brachytherapy is mainly recommended for breast cancer, endometrial, cervical cancer or nonmelanomatous skin cancers based on currently available data, however, electronic brachytherapy has emerged as a potential alternative for certain disease sites [13].…”

Section: Introductionmentioning

confidence: 99%

Low-energy electronic intraoperative radiotherapy for pT3 locally advanced colon cancer: a single-institution retrospective analysis

Ma¹,

Qiang²,

Yin³

et al. 2020

Preprint

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Background Patients with locally advanced colon cancer (LACC) treated with surgery had a high risk of local recurrence. The outcomes can vary significantly among patients with pT3 disease. This study was undertaken to assess whether low-energy electronic intraoperative radiotherapy (eIORT) can achieve promising results comparing with electron beam IORT (IOERT) and whether specific subgroups of patients with pT3 colon cancer may benefit from eIORT. Methods We retrospectively reviewed 44 patients with pT3 LACC treated with eIORT. Clinicopathologic characteristics were analyzed to identify patients that could potentially benefit from eIORT. Kaplan-Meier survival analysis was used to assess overall survival (OS) and progression free survival (PFS). The log-rank test was used for the subgroup comparison. Results The median follow-up of patients was 20.5 months (range, 6.1–38.8 months). At the time of analysis, 38 (86%) were alive and 6 (14%) had died of their disease. The 3-year Kaplan-Meier of PFS and OS for the entire cohort were 82.8% and 82.1%, respectively. At median follow-up, no in-field failure within the eIORT field had occurred. Locoregional and distant failure had occurred in 2 (5%) patients each. The rate of perioperative 30-day mortality was 0% and morbidity rate was 11%. Five patients experienced 7 complications, including 4 early complications (30-d) and three late complications (>30 days) leading early and late morbidity rates of 9% and 7%, respectively. Conclusion Low-energy eIORT can be considered as part of management in pT3 LACC.

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The American Brachytherapy Society consensus statement on intraoperative radiation therapy

Cited by 57 publications

References 144 publications

Outcomes with intraoperative radiation therapy for early‐stage breast cancer

Outcomes with intraoperative radiation therapy for early‐stage breast cancer

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Low-energy electronic intraoperative radiotherapy for pT3 locally advanced colon cancer: a single-institution retrospective analysis

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