AIM: To determine the survival of advanced pancreatic cancer patients treated with intraoperative radiotherapy (IORT) combined with external beam radiation therapy (EBRT) following internal drainage (cholecystojejunos...AIM: To determine the survival of advanced pancreatic cancer patients treated with intraoperative radiotherapy (IORT) combined with external beam radiation therapy (EBRT) following internal drainage (cholecystojejunostomy or choledochojejunostomy). METHODS: Eighty-one patients with advanced pancreatic cancer who received IORT combined with EBRT following internal drainage (ID) between 1996 and 2001 were retrospectively analyzed. Among the 81 patients, 18 underwent ID+IORT, 25 ID+IORT+EBRT (meanwhile, given 5-Fu 300 mg/m^2 iv drip, 2f/w), 16 EBRT, 22 had undergone simple internal drainage. The IORT dose was 15-25Gy in a single fraction. The usual EBRT dose was 30-40Gy with a daily fraction of 1.8-2.0 Gy. RESULTS: The complete remission rate, partial remission rate of patients with backache and abdominal pain treated with ID+IORT were 55.5%, 33.3% respectively. Alleviation of pain was observed 2 or 3 wk after IORT. The median survival time (MST) of ID+IORT group was 10.7 mo. The pain remission rate of patients treated with ID+IORT+EBRT was 92%, and their MST was 12.2 mo. The MST of patients treated with EBRT and simple internal drainage was 5.1 mo and 7.0 mo, respectively. The survival curve of ID+IORT group and ID+IORT+EBRT group was significantly better than that of EBRT group (P<0.05). The difference between the ID+IORT+EBRT group and ID group was significant (P<0.05). CONCLUSION: IORT combined with EBRT following internal drainage can alleviate pain, improve quality of life and prolong survival time of patients with advanced pancreatic cancer.展开更多
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 ...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.展开更多
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 T...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.展开更多
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 ...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.展开更多
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...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.展开更多
基金Supported by the Technology Project Entry Foundation of ShaanxiProvince,No.2002K10-G3
文摘AIM: To determine the survival of advanced pancreatic cancer patients treated with intraoperative radiotherapy (IORT) combined with external beam radiation therapy (EBRT) following internal drainage (cholecystojejunostomy or choledochojejunostomy). METHODS: Eighty-one patients with advanced pancreatic cancer who received IORT combined with EBRT following internal drainage (ID) between 1996 and 2001 were retrospectively analyzed. Among the 81 patients, 18 underwent ID+IORT, 25 ID+IORT+EBRT (meanwhile, given 5-Fu 300 mg/m^2 iv drip, 2f/w), 16 EBRT, 22 had undergone simple internal drainage. The IORT dose was 15-25Gy in a single fraction. The usual EBRT dose was 30-40Gy with a daily fraction of 1.8-2.0 Gy. RESULTS: The complete remission rate, partial remission rate of patients with backache and abdominal pain treated with ID+IORT were 55.5%, 33.3% respectively. Alleviation of pain was observed 2 or 3 wk after IORT. The median survival time (MST) of ID+IORT group was 10.7 mo. The pain remission rate of patients treated with ID+IORT+EBRT was 92%, and their MST was 12.2 mo. The MST of patients treated with EBRT and simple internal drainage was 5.1 mo and 7.0 mo, respectively. The survival curve of ID+IORT group and ID+IORT+EBRT group was significantly better than that of EBRT group (P<0.05). The difference between the ID+IORT+EBRT group and ID group was significant (P<0.05). CONCLUSION: IORT combined with EBRT following internal drainage can alleviate pain, improve quality of life and prolong survival time of patients with advanced pancreatic cancer.
文摘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.
文摘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.
文摘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.
文摘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.
