PURPOSE: Intraoperative radiation therapy (IORT) allows delivery of tumoricidal doses of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. IORT using high-dose-rate (HDR) brachytherapy allows dose modulation and delivery of concomitant boosts to high-risk areas. This study describes a novel technique of HDR-IORT with dose painting (DP) (HDR-IORT-DP) and evaluates the clinical outcomes. METHODS AND MATERIALS: Sixteen patients with recurrent cancers received HDR-IORT-DP at the time of radical resection. Of these patients, 13 had colorectal cancer, 2 had head and neck cancer, and 1 had a gynecologic malignancy. All received external beam radiation previously. Negative margin (R0) was obtained in 12 patients (75%) and microscopically positive margins (R1) in 4 patients (25%). RESULTS: The median total target and boost area were 45 and 8.5cm(2), and HDR-IORT and boost dose were 1500 and 1750cGy, respectively. Median followup was 14.9 months. The 2-year local control and overall survival were 80% and 20%, respectively. Eleven patients (69%) developed distant metastasis and were deceased at the time of the last followup. A total of 13 patients (19%) developed Grade 3 toxicity related to HDR-IORT; no grade 4+ toxicities were observed. CONCLUSIONS: HDR-IORT-DP technique is feasible, safe, and allows for dose escalation in locally advanced or recurrent previously irradiated tumors. To our knowledge, this is the first clinical report on HDR-IORT-DP. Further studies are warranted to evaluate efficacy in a larger patient cohort. Local control was encouraging in our patients.
PURPOSE: Intraoperative radiation therapy (IORT) allows delivery of tumoricidal doses of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. IORT using high-dose-rate (HDR) brachytherapy allows dose modulation and delivery of concomitant boosts to high-risk areas. This study describes a novel technique of HDR-IORT with dose painting (DP) (HDR-IORT-DP) and evaluates the clinical outcomes. METHODS AND MATERIALS: Sixteen patients with recurrent cancers received HDR-IORT-DP at the time of radical resection. Of these patients, 13 had colorectal cancer, 2 had head and neck cancer, and 1 had a gynecologic malignancy. All received external beam radiation previously. Negative margin (R0) was obtained in 12 patients (75%) and microscopically positive margins (R1) in 4 patients (25%). RESULTS: The median total target and boost area were 45 and 8.5cm(2), and HDR-IORT and boost dose were 1500 and 1750cGy, respectively. Median followup was 14.9 months. The 2-year local control and overall survival were 80% and 20%, respectively. Eleven patients (69%) developed distant metastasis and were deceased at the time of the last followup. A total of 13 patients (19%) developed Grade 3 toxicity related to HDR-IORT; no grade 4+ toxicities were observed. CONCLUSIONS: HDR-IORT-DP technique is feasible, safe, and allows for dose escalation in locally advanced or recurrent previously irradiated tumors. To our knowledge, this is the first clinical report on HDR-IORT-DP. Further studies are warranted to evaluate efficacy in a larger patient cohort. Local control was encouraging in our patients.
Authors: Stephanie Terezakis; Lisa Morikawa; Abraham Wu; Zhigang Zhang; Weiji Shi; Martin R Weiser; Philip B Paty; Jose Guillem; Larissa Temple; Garrett M Nash; Michael J Zelefsky; Karyn A Goodman Journal: Ann Surg Oncol Date: 2015-01-29 Impact factor: 5.344
Authors: An-Sofie E Verrijssen; Wim J F Dries; Jeltsje S Cnossen; Jacqueline Theuws; Heike M U Peulen; Hetty A van den Berg; Dorien C Rijkaart; Eva L K Voogt; Inger-Karine Kolkman-Deurloo; Joost Nuyttens; Harm J T Rutten; Jacobus W A Burger; Cathryn Huibregtse Bimmel-Nagel Journal: J Contemp Brachytherapy Date: 2022-07-21
Authors: Anthony Pham; Shruthi Arora; A Gabriella Wernicke; David I Kutler; Marc Cohen; William Kuhel; Samuel Trichter; Dattatreyudu Nori; Silvia C Formenti; Bhupesh Parashar Journal: J Contemp Brachytherapy Date: 2015-12-30