The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Falk Roeder - One of the best experts on this subject based on the ideXlab platform.
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Intraoperative Radiation Therapy iort for soft tissue sarcoma estro iort task force acrop recommendations
Radiotherapy and Oncology, 2020Co-Authors: Falk Roeder, Felipe A Calvo, Philip Poortmans, Virginia Morillo, Ladan Salehebrahimi, Carlos Ferrer AlbiachAbstract:Abstract Purpose To describe guidelines for the use of Intraoperative Radiation Therapy (IORT) in the treatment of soft-tissue sarcomas (STS). Methods A panel of experts in the field performed a systematic literature review, supplemented their clinical experience and developed recommendations for the use of IORT in the treatment of STS. Results Based on the evidence from the systematic literature review and the clinical experience of the panel members, recommendations regarding patient selection, incorporation into multimodal treatment concepts and the IORT procedure itself are made. The rationale for IORT in extremity and retroperitoneal STS is summarized and results of the major series in terms of patient and treatment characteristics, oncological outcome and toxicity are presented. We define surgical factors, volumes for irRadiation, technical requirements, dose prescription, recording and reporting, treatment delivery and care during the course of IORT covering the main IORT techniques used for the treatment of STS. In extremity STS, evidence originates from a few small prospective and mainly from retrospective single centre studies. Based on those reports, IORT containing-approaches result in very high local control rates with low rates of acute and late toxicity. In retroperitoneal sarcomas, evidence is derived from one prospective randomized trial, a few prospective and a large number of retrospective studies. The randomized trial compared IORT combined with moderate doses of postoperative external-beam Radiation Therapy (EBRT) to high-dose postoperative EBRT alone after gross total resection, clearly favouring the IORT-containing approach. These results have been confirmed by the prospective and retrospective studies, which similarly showed high local control rates with acceptable toxicity, mainly favouring combinations of preoperative EBRT and IORT. Conclusions IORT-containing approaches result in high rates of local control with low to acceptable toxicity rates. Based on the available evidence, we made recommendations for the use of IORT in STS. Clinicians and researchers are encouraged to use these guidelines in clinical routine as well as in the design of future trials.
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estro iort task force acrop recommendations for Intraoperative Radiation Therapy in borderline resected pancreatic cancer
Clinical and Translational Radiation Oncology, 2020Co-Authors: Frank W Hensley, Felipe A Calvo, Philip Poortmans, Falk Roeder, Robert Krempien, Jose Manuel Asencio, Marco KrengliAbstract:Abstract Radiation Therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative Radiation Therapy (IORT) is a very precise RT modality to intensify the irRadiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoRadiation strategies in the context of active systemic Therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoRadiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemoTherapy followed by chemoRadiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic Therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer.
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Intraoperative Radiation Therapy iort in soft tissue sarcoma
Radiation Oncology, 2017Co-Authors: Falk Roeder, Robert KrempienAbstract:Soft-tissue sarcoma (STS) represent a rare tumor entity, accounting for less than 1% of adult malignancies. The cornerstone of curative intent treatment is surgery with free margins, although the extent of the surgical approach has been subject to change in the last decades. Multimodal approaches usually including Radiation Therapy have replaced extensive surgical procedures in order to preserve functionality while maintaining adequate local control. However, the possibility to apply adequate Radiation doses by external beam Radiation Therapy (EBRT) can be limited in some situation especially in case of directly adjacent organs at risk with low Radiation tolerance. Application of at least a part of the total dose via Intraoperative Radiation Therapy (IORT) with a single fraction during the surgical procedure may overcome those limitations, because radiosensitive structures can be moved out of the Radiation field resulting in reduced toxicity while the enhanced biological effectivity of the high single dose improves local control. The current review summarizes rationale, techniques, oncological and functional outcomes including possible pitfalls and associated toxicities based on the published literature for IORT focusing on extremity and retroperitoneal STS. In extremity STS, combination of limb-sparing surgery, IORT and pre- or postoperative EBRT with moderate doses consistently achieved excellent local control rates at least comparable to approaches using EBRT alone but usually including patient cohorts with higher proportions of unfavourable prognostic factors. Further on, IORT containing approaches resulted in very high limb preservation rates and good functional outcome, probably related to the smaller high dose volume. In retroperitoneal STS, the combination of preoperative EBRT, surgery and IORT consistently achieved high local control rates which seem superior to surgery alone or surgery with EBRT at least with regard to local control and in some reports even to overall survival. Further on, preoperative EBRT in combination with IORT seems to be superior to the opposite combination with regard to local control and toxicity. No major differences in wound healing disturbances or postoperative complication rates can be observed with IORT compared to non-IORT containing approaches. Neuropathy of major nerves remains a dose limiting toxicity requiring dose restrictions or exclusion from target volume. Gastrointestinal structures and ureters should be excluded from the IORT area whenever possible and the IORT volume should be restricted to the available minimum. Nevertheless, IORT represents an ideal boosting method if combined with EBRT and properly executed by experiences users which should be further evaluated preferably in prospective randomized trials.
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Intraoperative Radiation Therapy (IORT) in pancreatic cancer
Radiation Oncology, 2017Co-Authors: Robert Krempien, Falk RoederAbstract:Despite the important improvements made in the fields of surgery, chemoTherapy and Radiation Therapy, pancreatic cancer remains one of the most lethal malignancies. Improved outcomes with novel chemoTherapy regimes led again to increased attention on the role of localized radioTherapy, since local tumor progression causes significant morbidity and mortality in patients. Even after resection local failure rates are as high as 50–80%. The immediate proximity to critical structures (bone marrow, spinal cord, kidneys, liver, and intestine) limits the dose of Radiation that can be administered to the tumor bed with conventional external beam Radiation Therapy (EBRT). The Intraoperative radioTherapy (IORT) appears to be an ideal therapeutic strategy for this disease, having the advantage of enabling the delivery of high doses of Radiation to areas that are at risk for microscopic disease, saving critical organs and reducing the possibility of inducing radiotoxicity. This technique allows a theoretical increase in the Radiation therapeutic index to tumor compared to the adjacent organs at risk (OAR). The aim of this review is to update and comment on IORT in the multidisciplinary management of pancreatic cancer.
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outcomes in a multi institutional cohort of patients treated with Intraoperative Radiation Therapy for advanced or recurrent renal cell carcinoma
International Journal of Radiation Oncology Biology Physics, 2012Co-Authors: Jonathan J Paly, Christopher L Hallemeier, Gerd Fastner, Peter J Biggs, Felipe A Calvo, Falk Roeder, Andrzej Niemierko, Rafael Martinezmonge, Jared M Whitson, Felix SedlmayerAbstract:Purpose/Objective(s) This study aimed to analyze outcomes in a multi-institutional cohort of patients with advanced or recurrent renal cell carcinoma (RCC) who were treated with Intraoperative Radiation Therapy (IORT). Methods and Materials Between 1985 and 2010, 98 patients received IORT for advanced or locally recurrent RCC at 9 institutions. The median follow-up time for surviving patients was 3.5 years. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were estimated with the Kaplan-Meier method. Chained imputation accounted for missing data, and multivariate Cox hazards regression tested significance. Results IORT was delivered during nephrectomy for advanced disease (28%) or during resection of locally recurrent RCC in the renal fossa (72%). Sixty-nine percent of the patients were male, and the median age was 58 years. At the time of primary resection, the T stages were as follows: 17% T1, 12% T2, 55% T3, and 16% T4. Eighty-seven percent of the patients had a visibly complete resection of tumor. Preoperative or postoperative external beam Radiation Therapy was administered to 27% and 35% of patients, respectively. The 5-year OS was 37% for advanced disease and 55% for locally recurrent disease. The respective 5-year DSS was 41% and 60%. The respective 5-year DFS was 39% and 52%. Initial nodal involvement (hazard ratio [HR] 2.9-3.6, P P P P =.03). For locally recurrent tumors, positive margin status (HR 2.6, P =.01) was associated with decreased OS. Conclusions We report the largest known cohort of patients with RCC managed by IORT and have identified several factors associated with survival. The outcomes for patients receiving IORT in the setting of local recurrence compare favorably to similar cohorts treated by local resection alone suggesting the potential for improved DFS with IORT.
Felipe A Calvo - One of the best experts on this subject based on the ideXlab platform.
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estro iort task force acrop recommendations for Intraoperative Radiation Therapy with electrons ioert in breast cancer
Radiotherapy and Oncology, 2020Co-Authors: Gerd Fastner, Elena Sperk, Felipe A Calvo, Christoph Gaisberger, Julia Kaiser, Philipp Scherer, A Ciabattoni, Anna Petoukhova, Philip Poortmans, Felix SedlmayerAbstract:Abstract The aim of this review is to provide a comprehensive overview of the role of Intraoperative Radiation Therapy with electrons (IOERT) in breast conserving Therapy (BCT), both as partial breast irRadiation (PBI) as well as anticipated boost (“IOERT-Boost”). For both applications, the criteria for patient selection, technical details/requirements, physical aspects and outcome data are presented. IOERT as PBI The largest evidence comes from Italian studies, especially the ELIOT randomized trial. Investigators showed that the rate of in-breast relapses (IBR) in the IOERT group was significantly greater than with whole breast irRadiation (WBI), even when within the pre-specified equivalence margin. Tumour sizes >2 cm, involved axillary nodes, Grade 3 and triple negative molecular subtypes emerged as statistically significant predictors of IBR. For patients at low risk for in-breast recurrence (ASTRO/ESTRO recommendations), full dose IOERT was isoeffective with standard WBI. Hence, several national guidelines now include this treatment strategy as one of the standard techniques for PBI in carefully selected patients. IOERT Boost The largest evidence for boost IOERT preceding WBI comes from pooled analyses performed by the European Group of the International Society of Intraoperative Radiation Therapy (ISIORT Europe), where single boost doses (mostly around 10 Gy) preceded whole-breast irRadiation (WBI) with 50 Gy (conventional fractionation). At median follow-up periods up to ten years, local recurrence rates around 1% were observed for low risk tumours. Higher local relapse rates were described for grade 3 tumours, triple negative breast cancer as well as for patients treated after primary systemic Therapy for locally advanced tumours. Even in this settings, long-term (>5y) local tumour control rates beyond 95% were achieved. These encouraging results are interpreted as being attributable to utmost precision in dose delivery (by avoiding a “geographic and/or temporal miss”), and the possible radiobiological superiority of a single high dose fraction, compared to the conventionally fractionated boost. IOERT also showed favourable results in terms of cosmetic outcome, assumedly thanks to the small treated volumes combined with complete skin sparing.
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Intraoperative Radiation Therapy iort for soft tissue sarcoma estro iort task force acrop recommendations
Radiotherapy and Oncology, 2020Co-Authors: Falk Roeder, Felipe A Calvo, Philip Poortmans, Virginia Morillo, Ladan Salehebrahimi, Carlos Ferrer AlbiachAbstract:Abstract Purpose To describe guidelines for the use of Intraoperative Radiation Therapy (IORT) in the treatment of soft-tissue sarcomas (STS). Methods A panel of experts in the field performed a systematic literature review, supplemented their clinical experience and developed recommendations for the use of IORT in the treatment of STS. Results Based on the evidence from the systematic literature review and the clinical experience of the panel members, recommendations regarding patient selection, incorporation into multimodal treatment concepts and the IORT procedure itself are made. The rationale for IORT in extremity and retroperitoneal STS is summarized and results of the major series in terms of patient and treatment characteristics, oncological outcome and toxicity are presented. We define surgical factors, volumes for irRadiation, technical requirements, dose prescription, recording and reporting, treatment delivery and care during the course of IORT covering the main IORT techniques used for the treatment of STS. In extremity STS, evidence originates from a few small prospective and mainly from retrospective single centre studies. Based on those reports, IORT containing-approaches result in very high local control rates with low rates of acute and late toxicity. In retroperitoneal sarcomas, evidence is derived from one prospective randomized trial, a few prospective and a large number of retrospective studies. The randomized trial compared IORT combined with moderate doses of postoperative external-beam Radiation Therapy (EBRT) to high-dose postoperative EBRT alone after gross total resection, clearly favouring the IORT-containing approach. These results have been confirmed by the prospective and retrospective studies, which similarly showed high local control rates with acceptable toxicity, mainly favouring combinations of preoperative EBRT and IORT. Conclusions IORT-containing approaches result in high rates of local control with low to acceptable toxicity rates. Based on the available evidence, we made recommendations for the use of IORT in STS. Clinicians and researchers are encouraged to use these guidelines in clinical routine as well as in the design of future trials.
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estro iort task force acrop recommendations for Intraoperative Radiation Therapy in borderline resected pancreatic cancer
Clinical and Translational Radiation Oncology, 2020Co-Authors: Frank W Hensley, Felipe A Calvo, Philip Poortmans, Falk Roeder, Robert Krempien, Jose Manuel Asencio, Marco KrengliAbstract:Abstract Radiation Therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative Radiation Therapy (IORT) is a very precise RT modality to intensify the irRadiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoRadiation strategies in the context of active systemic Therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoRadiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemoTherapy followed by chemoRadiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic Therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer.
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Intraoperative Radiation Therapy opportunities for clinical practice normalization data recording and innovative development
Reports of Practical Oncology & Radiotherapy, 2014Co-Authors: Felipe A Calvo, Claudio V Sole, J A Santos, Morena Sallabanda, C Gonzalez, Laura Alonso Murillo, Javier Martinezvillanueva, Javier Serrano, Ana Alavrez, J M BlancoAbstract:Background Intraoperative radioTherapy (IORT) refers to the delivery of a high dose of Radiation at the time of surgery.
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research opportunities in Intraoperative Radiation Therapy the next decade 2013 2023
Clinical & Translational Oncology, 2013Co-Authors: Felipe A Calvo, Claudio V Sole, M E Gonzalez, E D Tangco, J Lopeztarjuelo, I Koubychine, J A SantosAbstract:The reality of Intraoperative Radiation Therapy (IORT) practice is consistent with an efficient and highly precise Radiation Therapy technique to safely boost areas at risk for local recurrence. Long-term clinical experience has shown that IORT-containing multi-modality regimens appear to improve local disease control, if not survival in many diseases. Research with IORT is a multidisciplinary scenario that covers knowledge from Radiation beam adapted development to advance molecular biology for bio-predictability of outcome. The technical parameters employed in IORT procedures are important information to be recorded for quality assurance and clinical results analysis. In addition, specific treatment planning systems for IORT procedures are available, to help in the treatment decision-making process. A systematic revision of opportunities for research and innovation in IORT is reported including Radiation beam modulation, delivery, dosimetry and planning; infrastructure and treatment factors; experimental and clinical radiobiology; clinical trials, innovation and translational research development.
Robert Krempien - One of the best experts on this subject based on the ideXlab platform.
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estro iort task force acrop recommendations for Intraoperative Radiation Therapy in borderline resected pancreatic cancer
Clinical and Translational Radiation Oncology, 2020Co-Authors: Frank W Hensley, Felipe A Calvo, Philip Poortmans, Falk Roeder, Robert Krempien, Jose Manuel Asencio, Marco KrengliAbstract:Abstract Radiation Therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative Radiation Therapy (IORT) is a very precise RT modality to intensify the irRadiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoRadiation strategies in the context of active systemic Therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoRadiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemoTherapy followed by chemoRadiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic Therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer.
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Intraoperative Radiation Therapy iort in soft tissue sarcoma
Radiation Oncology, 2017Co-Authors: Falk Roeder, Robert KrempienAbstract:Soft-tissue sarcoma (STS) represent a rare tumor entity, accounting for less than 1% of adult malignancies. The cornerstone of curative intent treatment is surgery with free margins, although the extent of the surgical approach has been subject to change in the last decades. Multimodal approaches usually including Radiation Therapy have replaced extensive surgical procedures in order to preserve functionality while maintaining adequate local control. However, the possibility to apply adequate Radiation doses by external beam Radiation Therapy (EBRT) can be limited in some situation especially in case of directly adjacent organs at risk with low Radiation tolerance. Application of at least a part of the total dose via Intraoperative Radiation Therapy (IORT) with a single fraction during the surgical procedure may overcome those limitations, because radiosensitive structures can be moved out of the Radiation field resulting in reduced toxicity while the enhanced biological effectivity of the high single dose improves local control. The current review summarizes rationale, techniques, oncological and functional outcomes including possible pitfalls and associated toxicities based on the published literature for IORT focusing on extremity and retroperitoneal STS. In extremity STS, combination of limb-sparing surgery, IORT and pre- or postoperative EBRT with moderate doses consistently achieved excellent local control rates at least comparable to approaches using EBRT alone but usually including patient cohorts with higher proportions of unfavourable prognostic factors. Further on, IORT containing approaches resulted in very high limb preservation rates and good functional outcome, probably related to the smaller high dose volume. In retroperitoneal STS, the combination of preoperative EBRT, surgery and IORT consistently achieved high local control rates which seem superior to surgery alone or surgery with EBRT at least with regard to local control and in some reports even to overall survival. Further on, preoperative EBRT in combination with IORT seems to be superior to the opposite combination with regard to local control and toxicity. No major differences in wound healing disturbances or postoperative complication rates can be observed with IORT compared to non-IORT containing approaches. Neuropathy of major nerves remains a dose limiting toxicity requiring dose restrictions or exclusion from target volume. Gastrointestinal structures and ureters should be excluded from the IORT area whenever possible and the IORT volume should be restricted to the available minimum. Nevertheless, IORT represents an ideal boosting method if combined with EBRT and properly executed by experiences users which should be further evaluated preferably in prospective randomized trials.
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Intraoperative Radiation Therapy (IORT) in pancreatic cancer
Radiation Oncology, 2017Co-Authors: Robert Krempien, Falk RoederAbstract:Despite the important improvements made in the fields of surgery, chemoTherapy and Radiation Therapy, pancreatic cancer remains one of the most lethal malignancies. Improved outcomes with novel chemoTherapy regimes led again to increased attention on the role of localized radioTherapy, since local tumor progression causes significant morbidity and mortality in patients. Even after resection local failure rates are as high as 50–80%. The immediate proximity to critical structures (bone marrow, spinal cord, kidneys, liver, and intestine) limits the dose of Radiation that can be administered to the tumor bed with conventional external beam Radiation Therapy (EBRT). The Intraoperative radioTherapy (IORT) appears to be an ideal therapeutic strategy for this disease, having the advantage of enabling the delivery of high doses of Radiation to areas that are at risk for microscopic disease, saving critical organs and reducing the possibility of inducing radiotoxicity. This technique allows a theoretical increase in the Radiation therapeutic index to tumor compared to the adjacent organs at risk (OAR). The aim of this review is to update and comment on IORT in the multidisciplinary management of pancreatic cancer.
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aggressive local treatment containing Intraoperative Radiation Therapy iort for patients with isolated local recurrences of pancreatic cancer a retrospective analysis
BMC Cancer, 2012Co-Authors: Falk Roeder, Robert Krempien, Gregor Habl, Peter E Huber, Carmen Timke, M Uhl, F Hensley, Markus W BuechlerAbstract:To evaluate the use of Intraoperative Radiation Therapy (IORT) in the multimodality treatment of patients with isolated local recurrences of pancreatic cancer. We retrospectively analyzed 36 patients with isolated local recurrences of pancreatic cancer who have been treated with a combination of surgery, IORT and EBRT. Median time from initial treatment to recurrence was 20 months. All patients were surgically explored. In 18 patients a gross total resection was achieved, whereas the other half received only debulking or no resection at all. All patients received IORT with a median dose of 15 Gy. Additional EBRT was applied to 31 patients with a median dose of 45 Gy, combined with concurrent, mainly gemcitabine-based chemoTherapy. Median follow-up in surviving patients was 23 months. Local progression was found in 6 patients after a median time of 17 months, resulting in estimated 1- and 2-year local control rates of 91% and 67%, respectively. Distant failure was observed in 23 patients, mainly in liver or peritoneal space. The median estimated progression-free survival was 9 months with 1- and 2-year rates of 40% and 26%, respectively. We found an encouraging estimated median overall survival of 19 months, transferring into 1- and 2-year rates of 66% and 45%. Notably 6 of 36 patients (17%) lived for more than 3 years. Severe postoperative complications were found in 3 and chemoRadiation-related grade III toxicity in 6 patients. No severe IORT related toxicity was observed. Combination of surgery, IORT and EBRT in patients with isolated local recurrences of pancreatic cancer resulted in encouraging local control and overall survival in our cohort with acceptable toxicity. Our approach seems to be superior to palliative chemoTherapy or chemoRadiation alone and should be further investigated in a prospective setting specifically addressing isolated local recurrences of pancreatic cancer.
Peter E Huber - One of the best experts on this subject based on the ideXlab platform.
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aggressive local treatment containing Intraoperative Radiation Therapy iort for patients with isolated local recurrences of pancreatic cancer a retrospective analysis
BMC Cancer, 2012Co-Authors: Falk Roeder, Robert Krempien, Gregor Habl, Peter E Huber, Carmen Timke, M Uhl, F Hensley, Markus W BuechlerAbstract:To evaluate the use of Intraoperative Radiation Therapy (IORT) in the multimodality treatment of patients with isolated local recurrences of pancreatic cancer. We retrospectively analyzed 36 patients with isolated local recurrences of pancreatic cancer who have been treated with a combination of surgery, IORT and EBRT. Median time from initial treatment to recurrence was 20 months. All patients were surgically explored. In 18 patients a gross total resection was achieved, whereas the other half received only debulking or no resection at all. All patients received IORT with a median dose of 15 Gy. Additional EBRT was applied to 31 patients with a median dose of 45 Gy, combined with concurrent, mainly gemcitabine-based chemoTherapy. Median follow-up in surviving patients was 23 months. Local progression was found in 6 patients after a median time of 17 months, resulting in estimated 1- and 2-year local control rates of 91% and 67%, respectively. Distant failure was observed in 23 patients, mainly in liver or peritoneal space. The median estimated progression-free survival was 9 months with 1- and 2-year rates of 40% and 26%, respectively. We found an encouraging estimated median overall survival of 19 months, transferring into 1- and 2-year rates of 66% and 45%. Notably 6 of 36 patients (17%) lived for more than 3 years. Severe postoperative complications were found in 3 and chemoRadiation-related grade III toxicity in 6 patients. No severe IORT related toxicity was observed. Combination of surgery, IORT and EBRT in patients with isolated local recurrences of pancreatic cancer resulted in encouraging local control and overall survival in our cohort with acceptable toxicity. Our approach seems to be superior to palliative chemoTherapy or chemoRadiation alone and should be further investigated in a prospective setting specifically addressing isolated local recurrences of pancreatic cancer.
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clinical phase i ii trial to investigate preoperative dose escalated intensity modulated Radiation Therapy imrt and Intraoperative Radiation Therapy iort in patients with retroperitoneal soft tissue sarcoma interim analysis
BMC Cancer, 2012Co-Authors: Falk Roeder, Ladan Salehebrahimi, Alexis Ulrich, Gregor Habl, Peter E Huber, Daniela SchulzertnerAbstract:Background Local control rates in patients with retroperitoneal soft tissue sarcoma (RSTS) remain disappointing even after gross total resection, mainly because wide margins are not achievable in the majority of patients. In contrast to extremity sarcoma, postoperative Radiation Therapy (RT) has shown limited efficacy due to its limitations in achievable dose and coverage. Although Intraoperative Radiation Therapy (IORT) has been introduced in some centers to overcome the dose limitations and resulted in increased outcome, local failure rates are still high even if considerable treatment related toxicity is accepted. As postoperative administration of RT has some general disadvantages, neoadjuvant approaches could offer benefits in terms of dose escalation, target coverage and reduction of toxicity, especially if highly conformal techniques like intensity-modulated Radiation Therapy (IMRT) are considered.
Christopher G Willett - One of the best experts on this subject based on the ideXlab platform.
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the role of Intraoperative Radiation Therapy in patients with pancreatic cancer
Seminars in Radiation Oncology, 2014Co-Authors: Manisha Palta, Christopher G Willett, Brian G CzitoAbstract:Intraoperative Radiation Therapy (IORT) techniques allow for the delivery of high doses of Radiation Therapy while excluding part or all of the nearby dose-limiting sensitive structures. Therefore, the effective Radiation dose is increased and local tumor control potentially improved. This is pertinent in the case of pancreatic cancer because local failure rates are as high as 50%-80% in patients with resected and locally advanced disease. Available data in patients receiving IORT after pancreaticoduodenectomy reveal an improvement in local control, though overall survival benefit is unclear. Series of patients with locally advanced pancreatic cancer also suggest pain relief, and in select studies, improved survival associated with the inclusion of IORT. At present, no phase III data clearly supports the use of IORT in the management of pancreatic cancer.
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Intraoperative Radiation Therapy
Journal of Clinical Oncology, 2007Co-Authors: Christopher G Willett, Brian G Czito, Douglas S TylerAbstract:Intraoperative Radiation Therapy (IORT) is the delivery of irRadiation at the time of an operation. This is performed by different techniques including Intraoperative electron beam techniques and high-dose rate brachyTherapy. IORT is usually given in combination with external-beam Radiation Therapy with or without chemoTherapy and surgical resection. IORT excludes part or all dose-limiting sensitive structures, thereby increasing the effective dose to the tumor bed (and therefore local control) without significantly increasing normal tissue morbidity. Despite best contemporary Therapy, high rates of local failure occur in patients with locally advanced or recurrent rectal cancer, retroperitoneal sarcoma, select gynecologic cancers, and other malignancies. The addition of IORT to conventional treatment methods has improved local control as well as survival in many disease sites in both the primary and locally recurrent disease settings. More recently, there has been interest in the use of IORT as a technique of partial breast irRadiation for women with early breast cancer. Given newer and lower cost treatment devices, the use of IORT in clinical practice will likely grow, with increasing integration into the treatment of nonconventional malignancies. Optimally, phase III randomized trials will be carried out to prove its efficacy in these disease sites.
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Intraoperative Radiation Therapy
International Journal of Clinical Oncology, 2001Co-Authors: Christopher G WillettAbstract:The modern use of Intraoperative Radiation Therapy (IORT) was initiated by the studies of Abe and colleagues at the University of Kyoto. This work stimulated significant laboratory and clinical investigation into the use of IORT throughout Japan, Europe, and the United States. Because of this experience, single high doses of irRadiation can be safely delivered to a tumor volume in appropriate clinical situations. Most importantly, this high dose of additional Radiation treatment yields improved local control of selected tumors. Treatment programs of external beam Radiation Therapy, surgical resection, and IORT for patients with locally advanced primary and recurrent rectal carcinoma and retroperitoneal sarcoma have yielded excellent local control and higher survival rates. The future of IORT will be in the successful integration of this Therapy into multimodality treatment programs of chemoTherapy, external beam irRadiation, and surgery for locally advanced malignancies.
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Intraoperative Radiation Therapy for locally advanced recurrent rectal or rectosigmoid cancer
Radiotherapy and Oncology, 2001Co-Authors: Katja Lindel, Christopher G Willett, Paul C Shellito, Mark J Ott, Jeffrey W Clark, Michael L Grossbard, David P Ryan, Marek AncukiewiczAbstract:Abstract Background and purpose : To update and summarize the experience at the Massachusetts General Hospital of a treatment program of high-dose preoperative irRadiation, surgical re-resection, and Intraoperative Radiation Therapy (IORT) as a salvage treatment for patients with recurrent rectal or rectosigmoid carcinoma. Patients and methods : From June 1978 to February 1997, the records of 69 patients with locally recurrent rectal carcinomas or rectosigmoid carcinomas without metastases referred for consideration of IORT were reviewed. Forty-nine patients received IORT and local control and disease-free survival curves were calculated using the actuarial method of Kaplan–Meier. Results : The 5-year overall survival, local control and disease-free survival rates of 49 patients receiving IORT were 27, 35, and 20%, respectively. Thirty-four patients who underwent a macroscopic complete resection had a significantly better 5-year overall survival than the remaining 15 patients with gross residual disease (33 vs. 13%, P =0.05, log rank). For those patients, local control and disease-free survival rates were 46 and 27%, respectively. Patients with a microscopic complete resection had a superior 5-year overall survival than partially resected patients (40 vs. 14%, P =0.0001, log rank). ChemoTherapy had no significant influence on overall or disease-free survival. Conclusion : The current analysis shows the importance of a microscopic complete resection in a multi-modality approach with IORT for survival and local control. Salvage is rare for patients undergoing subtotal resection.
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Intraoperative Radiation Therapy for locally advanced recurrent rectal or rectosigmoid cancer
Journal of Surgical Oncology, 1995Co-Authors: Wallace H James, Christopher G Willett, Paul C Shellito, John J Coen, Herbert C HooverAbstract:Recurrent rectal or rectosigmoid cancer is a difficult therapeutic problem. A treatment program of external beam irRadiation, surgery, and Intraoperative irRadiation has been used for 41 patients. The 5-year actuarial local control and disease-free survival of all 41 patients was 30% and 16%, respectively. Subset analysis demonstrated differences in outcome by extent of surgical resection. The 5-year actuarial local control and disease-free survival of 27 patients undergoing complete resection was 47% and 21%, respectively. By contrast, the outcome of 14 patients undergoing partial resection was poor, with a 5-year actuarial local control and survival of 21% and 7%, respectively. Late complications included soft tissue or peripheral nerve injury, with many of these resolving within 4-18 months. Local control and disease-free survival rates are favorable in comparison with the results achieved by aggressive surgery. Patients who achieve a gross total resection at Intraoperative irRadiation have a markedly better prognosis than that of patients with residual gross disease.