Analysis of the Long-term Effect of Intraoperative Radiotherapy (IORT) for Non-Small Cell Lung Carcinoma (NSCLC)

OBJECTIVE To analyze the long-term effects of treatment with an op-eration + postoperative irradiation (A group) and an operation+intraoperative radiotherapy+postoperative irradiation (B group) in non-small cell lung cancer patients. METHODS Through a prospective randomized clinical trial, a total of 154 patients with non-small cell lung carcinoma were divided into two groups of 77 cases. Among the 154 cases, there were 134 squamous carcinomas, 17 adenocarcinomas and 3 adeno-squamous carcinomas. TNM staging: there were 17 in StageⅠ, 76 in Stage Ⅱ and 61 in Stage Ⅲ. A dosage of 15～25 Gy IORT, energy 9～16 MeV electrons, was delivered to the tumors. The doses given were 40～60 Gy postoperation. RESULTS The local control rates in A and B groups were 49.4% and 62.3% respectively (P<0.05). The survivals at 3, 5 and 7 years for group A were 40.3%, 27.3%, and 5.2% and for group B 44.2%, 28.6% and 6.5% (P>0.05). There were 16 deaths from radiotherapy complications, with 2 cases in group A and 14 in group B. CONCLUSION IORT+postoperative irradiation can enhance the local control rate of non-small cell lung cancer patients and reduce the recurrent rates, but it can not improve long-term survival.

Clinical Benefit with Intraoperative Radiotherapy Combined with Regional Chemotherapy for Advanced Pancreatic Carcinoma

Objective: To evaluate the effectiveness of intraoperative radiotherapy (IORT) in combination with regional chemotherapy in the treatment of advanced pancreatic carcinoma.Methods: 17 patients with advanced pancreatic adenocarcinoma were treated with IORT and regional chemotherapy with 5-FU, Epirubucin and Mitomycin, and 6 cases accepted external radiotherapy postoperatively.Results: 35.29% (6/17) of the patients were clinical benefit responders and 23.53% (4/17) had a partial response. The median survival time was 11 months and the 1-year survival rate was 35.29% (6/17)Conclusion: IORT in combination with regional chemotherapy had a good impact on clinical benefit without severe side effects in locally advanced pancreatic carcinoma and led to a significant prolongation of the survival time. Key words pancreatic cancer - intraoperative radiotherapy - chemotherapy

Evaluation of intraoperative radiotherapy for gastric carcinoma with D2 and D3 surgical resection

AIM： TO study the proper sites and doses of intraoperative radiotherapy （IORT） for gastric carcinoma and the effects of this treatment. METHODS： A total of 106 patients with stage Ⅰ -Ⅳ gastric carcinoma who received D2 or D3 radical operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body underwent distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligment area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach underwent proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional para-aorta. The therapeutic effects （including survival and complications） of these 106 cases received operation combined with IORT （IORT group） were compared with 441 cases treated during the same time period by a radical operation alone （operation group）. RESULTS： The radiation dose below 30 Gy was safe. The therapeutic method of the operation combined with IORT did not prolong the survival of patients with stage Ⅰ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved. The 5-year survival rates of the stages Ⅲ cancer patients receiving D2 resection combined with IORT were markedly improved, while for those receiving D3 radical resection, only the postoperative 3- or 4-year survival rates were improved （P 〈 0.005-0.001）. The 5-year survival rate for those patients was raised only by 4.7% （P 〉 0.05）. CONCLUSION： The 5-year survival rates of patients with stages Ⅱ and Ⅲ gastric carcinoma who received D2 lymphadenectomy combined with IORT were improved, and there was no influence on the postoperative complications and mortality.

Measurement and Comparison of Output Factors Using Two Detectors for NOVAC7 IntraOperative Radiotherapy Accelerator

The aim of this work was to evaluate and compare the performance of comparatively new synthetic PTW 60019 microDiamond with PTW 60017 Diode E detector in measuring the output factors (OF) of IntraOperative Radiation Therapy (IORT) electron beams. For a given electron beam, OFs are defined as the ratio of the dose for any applicator size at the depth of maximum to that for a reference applicator. IORT is an innovative treatment technique that delivers a large single fraction of radiation dose to the tumor bed during surgery. The electron beams considered in this study were generated by the mobile NOVAC7 system. This device produces high-dose-per-pulse electron beams with four different energies in the range from 3 MeV to 9 MeV. We performed measurements for two higher energies, namely 7MeV and 9 MeV. The beam collimation was performed through Perspex (PMMA) cylindrical applicators with different diameters. The accurate dose delivery of IORT tightly depends on the precision of measured dose by reference applicator and the output factors of clinical applicators. The output factors were measured using microDiamond and Diode E detectors. The microDiamond detector performance was compared with a Diode E detector. Determined output factors of two detectors were in good agreement. The maximum deviations of output factors for microDiamond were found 2.74%, and 2.17% for 7 MeV and 9 MeV, respectively with respect to the PTW Diode E. The microDiamond detector was shown to exhibit excellent properties for output factor measurements and could be considered as a suitable tool for electron beam dosimetry.

Efficacy and safety of intraoperative radiotherapy in rectal cancer:A systematic review and meta-analysis

BACKGROUND In recent years,intraoperative radiotherapy(IORT)has been increasingly used for the treatment of rectal cancer.However,the efficacy and safety of IORT for the treatment of rectal cancer are still controversial.AIM To evaluate the value of IORT for patients with rectal cancer.METHODS We searched PubMed,Embase,Cochrane Library,Web of Science databases,and conference abstracts and included randomized controlled trials and observational studies on IORT vs non-IORT for rectal cancer.Dichotomous variables were evaluated by odds ratio(OR)and 95%confidence interval(CI),hazard ratio(HR)and 95%CI was used as a summary statistic of survival outcomes.Statistical analyses were performed using Stata V.15.0 and Review Manager 5.3 software.RESULTS In this study,3 randomized controlled studies and 12 observational studies were included with a total of 1460 patients,who are mainly residents of Europe,the United States,and Asia.Our results did not show significant differences in 5-year overall survival(HR=0.80,95%CI=0.60-1.06;P=0.126);5-year disease-free survival(HR=0.94,95%CI=0.73-1.22;P=0.650);abscess(OR=1.10,95%CI=0.67-1.80;P=0.713),fistulae(OR=0.79,95%CI=0.33-1.89;P=0.600);wound complication(OR=1.21,95%CI=0.62-2.36;P=0.575);anastomotic leakage(OR=1.09,95%CI=0.59-2.02;P=0.775);and neurogenic bladder dysfunction(OR=0.69,95%CI=0.31-1.55;P=0.369).However,the meta-analysis of 5-year local control was significantly different(OR=3.07,95%CI=1.66-5.66;P=0.000).CONCLUSION The advantage of IORT is mainly reflected in 5-year local control,but it is not statistically significant for 5-year overall survival,5-year disease-free survival,and complications.

Intraoperative radiotherapy:principles and prospects

Intraoperative radiotherapy （IORT） in its broadest sense refers to the delivery of radiation at the time of an opera- tion. It includes multiple techniques, namely intraoperative electron irradiation, intraoperative brachytherapy and intraopera- rive photon irradiation. It has a wide range of existing and potentially enlarging clinical applications. We will discuss in this review the rationale for and use of intraoperative irradiation in conjunction with surgical exploration with or without external- beam irradiation （EBRT） and chemotherapy.

Mammographic Findings Associated with Accelerated Partial Breast Irradiation Using Single Fraction Intraoperative Radiotherapy

Purpose: To evaluate the mammographic findings of women treated with accelerated partial breast irradiation (APBI) using single-fraction intraoperative radiotherapy (IORT). Materials/Methods: Women ≥ 40 years of age with unifocal invasive or intraductal carcinoma ≤ 2.5 cm on physical examination, mammography, and ultrasound were enrolled on an APBI trial using single fraction IORT. Post-treatment mammographic imaging was obtained at 6 months, 1 year, and then annually. Results: Between 12/02 and 6/04, 17 women underwent IORT at the time of lumpectomy (median age = 60 years;range = 40 - 83). The initial post-IORT mammogram showed increased density at the lumpectomy site in 11 patients (65%), while six patients (35%) had architectural distortion in the area of the irradiated tissue. Fifteen patients (88%) had numerous punctate, benign-appearing calcifications corresponding to the irradiated region. There was focal skin thickening near the incision in 13 patients (76%). At a median of 67 months, architectural distortion had stabilized and the benign-appearing calcifications remained stable in number and character. Eight patients (47%) had mammographic findings consistent with fat necrosis, ranging in size from 0.5 - 4 cm. Conclusions: After lumpectomy and IORT, mammographic changes include increased density and benign appearing calcifications in the irradiated region with focal skin thickening. These changes appear to stabilize over time and are consistent with post-treatment changes. These changes are important to identify in order to characterize benign changes from recurrent tumor.

Experience with intraoperative radiotherapy for breast cancer: the Geneva University Hospital's experience

Background Breast conserving surgery along with adjuvant radiotherapy is effective in terms of local control and survival for early- stage breast cancer （1）. External beam radiotherapy （EBRT） following breast conserving surgery has been shown to improve survival by preventing local recurrence, in the Early Breast Cancer Trialists＇ Collaborative Group meta-analysis （2）. Standard radiotherapy typically requires numerous fractions over a 3-5 week period and is performed weeks or months after surgery or chemotherapy.

IORT在宫颈癌治疗中的应用体会

目的:对术中放射治疗(IORT)在宫颈癌患者中的应用进行初步评价。方法:回顾性分析181例宫颈癌患者应用IORT后的效果。结果:在9例宫颈癌复发患者中,1例IORT后9个月因全身多发转移死亡;1例在IORT后14个月阴道残端复发,余7例IORT后均无瘤生存至今。172例IORT宫颈癌Ⅱb期患者,5年无瘤生存率、5年生存率、5年局部控制率分别为86.5%、89.7%、94.5%;按鳞癌、腺癌、腺鳞癌分类,其5年生存率分别为93.2%、91.7%、56.0%。术后发生与IORT相关的并发症少且经保守治疗后大多可自愈。结论:IORT有很好的肿瘤原发部位的局部控制效果,不仅对宫颈复发癌是一项可供选择的治疗手段,对于Ⅱb期宫颈癌初治患者选择“经腹全子宫双附件切除术+选择性盆腔淋巴结剥除术+IORT”也是一项有进步意义的综合治疗方案。

Is current clinical practice modified about intraoperative breast irradiation?

After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy （IORT） instead of postoperative whole breast irradiation （WBI） after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Ontology （ASTRO） and Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology （GEC-ESTRO） and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

Intraoperative Radiation Therapy(INTRABEAM)Experience at the Mastology Unit Leopoldo Aguerrevere Clinic

Introduction: External radiation therapy has been the fundamental pillar when treating breast cancer. Partial radiation therapy and intraoperative radiation treatment have created modifications that allow the irradiation of the breast to be performed at the surgical act delivering a single large fraction or a “boost” dose directly at the tumor bed. We will discuss patients treated with INTRABEAM (Carl Zeiss Surgical Oberkochen, Germany) at the “Mastology Unit at Leopoldo Aguerrevere Clinic”. Materials and Methods: The selection of patients is crucial for the success of the treatment, same protocol of treatment has been applied to every patient at the surgical act. Since September 2013 until February 2015, we have treated a total of 148 patients with the INTRABEAM unit, we will discuss the 114 patients treated by the team at the “Mastology Unit at Leopoldo Aguerrevere Clinic” with ages between 31 and 87 years in which 46% were single treatments and 54% were treated as a “boost” for external radiation therapy. Results: The procedure has been well tolerated with only a 17% of transient fibrosis and a 12% of seromas. We have had none mayor complications like dehiscence of the wound or necrosis of the borders. Conclusion: With this preliminary presentation, we would like to demonstrate that the technique and protocol used at our mastology unit with the intraoperative radiation treatment is safe and has many advantages to the patients including better comfort, cost-effective and with results comparable to external radiotherapy.

乳腺癌放射治疗研究现状

乳腺癌是女性常见恶性肿瘤之一,在女性恶性肿瘤中发病率居于首位,给女性的生命健康带来了严重威胁。目前,针对乳腺癌的治疗包括外科手术治疗、放射治疗、化学治疗、内分泌治疗、免疫治疗、靶向治疗和姑息治疗等多种方式。放射治疗在乳腺癌治疗中扮演着不可或缺的角色,在不同治疗阶段对乳腺癌患者实施针对性的放射治疗,能显著提升临床治疗效果,提高患者生存率,有效抑制癌症复发,同时缓解患者症状,提升生活质量,进而不断优化乳腺癌放射相关的治疗策略。

进展期胰腺癌术中近距离放疗后并发胃瘫患者30例的营养管理

总结进展期胰腺癌术中近距离放疗后并发胃瘫患者30例的营养管理临床经验与成效,旨在为临床营养护理提供参考。护理重点为早期评估胃瘫患者营养不良、个体化营养教育、选择合适的营养通道、分阶段动态实施营养治疗及促进胃肠动力恢复。30例患者经精心护理后,在(3.4±0.38)周后恢复胃动力,体质量维持稳定,患者主观整体评估量表(patient-generated subjective globe assessment, PG-SGA)评分均≤5分;白蛋白、前白蛋白较前明显升高,营养状况明显改善,均顺利出院。

42例晚期胰腺癌的术中放射治疗

目的 探讨姑息性手术结合术中放射治疗对晚期胰腺癌的疗效。方法 对 4 2例未能切除的晚期胰腺癌患者进行姑息性手术合并术中放疗。用 9～ 16MeV电子线在直视下照射病灶区域 ,照射量 2 0～ 30Gy。同时与未行术中放疗的 5 9例患者进行对比。结果 术中放疗组患者腹痛和腰背痛完全缓解率为 6 6 .7% ,部分缓解率为 2 6 .2 % ,总有效率为 92 .9%。未行术中放疗的 5 9例患者腹痛和腰背痛完全缓解率为 15 .3% ,部分缓解率为 2 5 .4 % ,总有效率为 4 0 .7% (P <0 .0 0 1)。术中放疗组平均生存期为 16 .7个月 ,对照组为 11.9个月 (P >0 .0 5 )。结论 姑息性手术结合术中放疗能够有效地控制晚期胰腺癌患者的腹痛和腰背痛 ,改善生活质量 ,并可适当延长生存期。

术中放疗病人的麻醉管理

目的探讨术中放疗病人围术期麻醉管理特点和放射防护经验。方法回顾性总结54例使用移动式电子束术中放疗系统(MOBETRON放射系统)进行肿瘤术中放疗的病例,对围术期的麻醉管理和放射防护经验进行分析。结果术中放疗需要多学科良好协作,其麻醉管理除遵从全身麻醉的常规原则之外,还需要关注麻醉深度控制、病人体位及设备管理、放射防护、病人的放疗增敏、放疗并发症的预防等。结论围术期的充分准备,合理的麻醉管理和有效的工作流程,完善的监测,有助于维持病人呼吸循环稳定和内环境平衡,保证术中放疗的顺利实施。

射线防护在术中放疗联合乳腺癌保乳术中应用效果观察

目的:探讨铅防护用具在术中放疗联合乳腺癌保乳术中的应用效果。方法:将铅围脖和铅眼镜应用于29例术中放疗联合乳腺癌保乳术的患者,热释光计量仪采集患者甲状腺及眼晶体皮肤表面防护前后所接受的散射剂量,评估射线防护效果。结果:患侧乳腺同侧甲状腺在铅围脖防护前后皮肤表面接受散射剂量分别为(3 934.89±21.67)和(5.05±1.03)μSv,患侧乳腺对侧甲状腺在铅围脖防护前后皮肤表面接受散射剂量分别为(3 845.13±26.71)和(4.69±0.89)μSv,患侧乳腺同侧眼晶体在铅围脖防护前后皮肤表面接受散射剂量分别为(2 518.29±29.62)和(4.72±0.75)μSv,患侧乳腺对侧眼晶体在铅围脖防护前后皮肤表面接受散射剂量分别为(2 418.69±21.63)和(3.98±0.84)μSv,4个测量点防护后散射剂量均低于防护前(P<0.001)。结论:在术中放疗联合乳腺癌保乳术中应用铅防护用具,可有效减少患者的辐射伤害。

乳腺癌保乳手术加术中放疗40例临床分析

目的：研究乳癌保乳手术中采用术中放疗对疾病治疗的远期疗效。方法：对我院1998年1月～1999年12月40例Ⅰ-Ⅱb期的乳腺癌患者行肿瘤广泛切除＋腋窝淋巴结清扫术＋术中放疗术。结果：经5年随访观察，40例患者仅1例局部复发，其余患者均健在，无远处转移，无明显放疗反应，双乳对称，外形美观。结论：乳腺癌保乳治疗＋术中放疗对于患者的局部复发率及远期生存率均有较明显的影响，降低了局部复发率。

术中放射治疗手术室周围环境辐射防护分析

目的:分析使用Mobetron移动式术中放疗加速器手术室周围环境辐射剂量。方法:依据《电离辐射防护与辐射源安全基本标准》和《医用电子加速器卫生防护标准》,利用Radiagem 2000探测器、SG-2R辐射检测仪,对Mobetron可移动式术中放疗加速器手术室周边辐射环境进行测量。结果:在工作负荷为每周5例,每例照射20 Gy,照射能量12 MeV的条件下,手术室周边最大漏射区域漏射剂量率为27.7μSv/h,年漏射剂量为221.6μSv。结论:在目前工作负荷下,工作人员及公众所受到的辐射剂量远低于安全剂量限值。

INTRABEAM实施乳腺癌术中放疗系统临床应用观察(附20例报告)

目的:评价INTRABEAM术中放射治疗系统临床应用的安全性和优势。方法:INTRABEAM对20例保乳手术患者实施术中瘤床放疗,均为单次照射每次20Gy,施用器规格为4.5cm(范围1.5-5.0cm),治疗持续时间35.5-51分钟。结果:术中照射治疗后有3例发生治疗区局部积液,经抽吸并加压包扎后愈合,乳房水肿1例。结论:INTRABEAM术中放射治疗系统近期无明显毒副作用,INTRABEAM术中放射治疗系统是一项安全良好耐受性技术,病人乐于接受。

现代术中放疗的进展

文章回顾了现代术中放射治疗的历史进程,总结了术中放疗设备的进展和特点,对术中放疗理论基础、临床适应症的变化和拓展、主要并发症以及和其他治疗方法的联合应用进行了归纳。