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.

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.

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.

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.

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.

The role of intraoperative electron radiotherapy in centrally located hepatocellular carcinomas treated with narrow-margin (<1 cm) hepatectomy: a prospective, phase 2 study

Background: Postoperative radiotherapy (RT) is known to play an important role in the treatment of hepatocellular carcinomas (HCCs), but the specific role of intraoperative electron radiotherapy (IOERT) in HCCs remains unclear. The aim of this study was to investigate the safety and efficacy of IOERT in centrally located HCCs treated with narrow-margin (<1 cm) hepatectomy. Methods: This was a single-center, phase 2, prospective non-randomized controlled study, including 268 patients with centrally located HCCs who underwent narrow-margin hepatectomy. The patients were subsequently allocated to the IOERT group (n=59) or to the control group (n=65). The primary outcome of the study was to compare recurrence-free survival (RFS) between the IOERT group and the control group, and the secondary outcome was to compare overall survival (OS) rate between the two groups. Results: Of 268 patients enrolled, a total of 124 were included in the study: 59 in IOERT group, 65 in control group. The 1-, 2-, 3-year RFS rates were 79.3%, 62.1% and 45.8% for patients in the IOERT group, and 47.6%, 28.6%, and 22.9% for patients in the control group, respectively (P=0.025). The 1-, 2-, and 3-year OS rates were 100.0%, 94.9%, and 83.7% for patients in the IOERT group, and 92.3%, 87.5%, and 79.4% for patients in the control group, respectively (P=0.314). Subgroup analysis of MVI (+) patients revealed that RFS and OS are significantly prolonged in the IOERT subgroup as compared to the control, whereas there was no significant difference of RFS and OS between the two groups in MVI (−) patients. Conclusions: IOERT for centrally located HCCs with concurrent narrow-margin hepatectomy was feasible and safe. Statistically better RFS rate was observed in the IOERT group compared to the control group. Subgroup analysis revealed that IOERT was more beneficial for postoperative survival of HCC patients with MVI. Trial Registration: ChiCTR-TRC-12002802;www.who.int/ictrp.

Accelerated partial breast irradiation:Current evidence and future developments

Whole breast irradiation after breast-conserving surgery for early breast cancer has become one of the standard treatment modes for breast cancer and yields the same effect as radical surgery.Accelerated partial breast irradiation(APBI)as a substitute for whole breast irradiation for patients with early breast cancer is a hot spot in clinical research.APBI is characterised by simple high-dose local irradiation of the tumour bed in a short time,thus improving convenience for patients and saving costs.The implementation methods of APBI mainly include brachytherapy,external beam radiation therapy,and intraoperative radiotherapy.This review provides an overview of the clinical effects and adverse reactions of the main technologies of APBI and discusses the prospects for the future development of APBI.