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of being able to carefully control the depth of radiation penetration while providing a very uniform dose to the tumor bed. Applied with energies in the range of 3 MeV to 12 MeV, electron IORT can treat to depths of up to 4 cm over areas as large as 300 cm² (i.e. a 10 cm diameter circle) and takes only 1–3 minutes to deliver the prescribed radiation dose. A few hospitals built shielded operation rooms in which a conventional linear accelerator was installed to deliver the IORT radiation. This eliminated the complex logistics involved with patient transportation, but was so costly that only a few hospitals were able to use this approach. The breakthrough came in 1997, with the introduction of a miniaturized, self-shielded, mobile linear accelerator (Mobetron, IntraOp
Corporation, US) and a mobile but unshielded linear accelerator (Novac, Liac–SIT, Italy). More than 75,000 patients have been treated with electron IORT, almost half of them since the introduction of mobile electron IORT technology.
219:
there were a few anecdotal reports of long-term survivors. In the early 1980s, when the use of electron IORT was increasing and showed promising results for certain indications, a handful of hospitals installed othovoltage units in lightly shielded ORs to see if this lower cost approach could achieve comparable results to that of electron IORT. This approach was less costly than building a shielded OR for an electron IORT unit and eliminated the logistics involved with patient transportation. However, it had a number of problems that limited its appeal. X-ray IORT has a poor uniformity of dose as a function of depth of penetration, the radiation does not stop at a pre-defined depth but continues to deposit radiation to underlying structures, and can do damage to boney structures if too high a dose is delivered. Despite its long use (since the 1930s), fewer than 1000 patients have been treated with this approach, and it is no longer offered at most centers.
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radiation centers already have an HDR system that can be transported to the OR when HDR-IORT is needed. HDR-IORT can also treat very large and convoluted surfaces. However, it does require a shielded OR or a shielded room in the OR complex to deliver the HDR-IORT. The depth of penetration is very limited, typically either ½ cm to 1 cm depth, sometimes requiring extensive surgery due to the limited penetration of the radiation. Treatments tend to be 40 minutes or longer, resulting in greater OR time, more anesthesia and greater blood loss when compared to electron IORT. There are about 10 to 20 active centers using HDR-IORT for locally advanced and recurrent disease, and approximately 2000 patients have received this treatment, mostly for colorectal cancer, head and neck cancer, and gynecologic cancer.
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tumor have several drawbacks: The tumor bed where the highest dose should be applied is frequently missed due to the complex localization of the wound cavity even when modern radiotherapy planning is used. Additionally, the usual delay between the surgical removal of the tumor and EBRT may allow a repopulation of the tumor cells. These potentially harmful effects can be avoided by delivering the radiation more precisely to the targeted tissues leading to immediate sterilization of residual tumor cells. Another aspect is that wound fluid has a stimulating effect on tumor cells. IORT was found to inhibit the stimulating effects of wound fluid.
244:(RBE) of low-energy X-rays on tumor cells is higher when compared to high-energy X-rays or gamma rays which are delivered by linear accelerators. The radiation which is produced by low-energy mobile radiation systems has a limited range. For this reason, conventional walls are regarded sufficient to stop the radiation scatter produced in the operating room and no extra measures for radiation protection are necessary. This makes IORT accessible for more hospitals.
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recurrent rectal cancer, skin cancer, retroperitoneal sarcoma, pancreatic cancer, and selected gynaecologic and genitourinary malignancies. For local recurrences, irradiation with IORT is, besides brachytherapy, the only radiotherapeutic option if repeated EBRT is no longer possible. Generally, the normal tissue tolerance does not allow a second full-dose course of EBRT, even after years.
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Early practitioners of IORT treated primarily abdominal malignancies using superficial X-rays (75–125 kV) and later orthovoltage x-rays (up to 300 kV in energy) prior to the advent of technology that enabled high-energy electrons. For the first 75 years, X-ray IORT was used mostly for palliation, but
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While IORT was first used in clinical practice in 1905, the modern era of IORT began with the introduction of electron IORT in the mid-1960s by transporting patients from the OR after the tumor was removed to the radiation department to receive their electron IORT. Electron IORT has the advantages
179:
On 25 July 2014, the UK National
Institute for Health and Care Excellence (NICE) gave provisional recommendation for the use of TARGIT IORT with Intrabeam in the UK National Health Service. The 2015 update of guidelines of the Association of Gynecological Oncology (AGO), an autonomous community of
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IORT was found to be useful and feasible in the multidisciplinary management of many solid tumors but further studies are needed to determine the benefit more precisely. Single-institution experiences have suggested a role of IORT e.g. in brain tumors and cerebral metastases, locally advanced and
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The rationale for IORT is to deliver a high dose of radiation precisely to the targeted area with minimal exposure of surrounding tissues which are displaced or shielded during the IORT. Conventional radiation techniques such as external beam radiotherapy (EBRT) following surgical removal of the
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This technique was developed in the late 1980s in an attempt to combine the dosimetric advantages of high-dose rate brachytherapy with the challenges of treating some complex anatomic surfaces with IORT. It has the advantage of being lower cost than dedicated electron IORT systems, since many
500:
Belletti, B.; Vaidya, J. S.; D'Andrea, S.; Entschladen, F.; Roncadin, M.; Lovat, F.; Berton, S.; Perin, T.; Candiani, E.; Reccanello, S.; Veronesi, A.; Canzonieri, V.; Trovo, M. G.; Zaenker, K. S.; Colombatti, A.; Baldassarre, G.; Massarut, S. (3 March 2008).
240:, Germany) received FDA and CE approval in 1999 and is a miniature mobile X-ray source which emits low-energy X-ray radiation (max. 50 kV) in isotropic distribution. Due to the higher ionization density caused by soft X-ray radiation in the tissue, the
687:
Furhang, Eli E.; Sillanpaa, Jussi K.; Hu, Kenneth S.; Harrison, Louis B. (2011). "HDR-IORT: Physics and
Techniques". In Gunderson, Leonard L.; Willett, Christopher G.; Calvo, Felipe A.; Harrison, Louis B. (eds.).
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Vaidya, Jayant S.; Bulsara, Max; Baum, Michael; Wenz, Frederik; Massarut, Samuele; Pigorsch, Steffi; Alvarado, Michael; Douek, Michael; Saunders, Christobel; Flyger, Henrik L.; Eiermann, Wolfgang (2020-08-19).
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the German
Society of Gynecology and Obstetrics (DGGG) and the German Cancer Society includes TARGIT IORT during lumpectomy as a recommended option for women with a T1, Grade 1 or 2, ER positive breast cancer.
541:
Comas C., Prio A. Irradiation roentgen intra-abdominale, après intervention chirurgicale dans un cas de cancer de l'uterus, Congres
International d'Electrologie. Imprenta Francesca Badia, Barcelona, pp 5-14,
840:"Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial"
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is a low-energy IORT technique. Evaluation of the long-term outcomes in patients who were treated with TARGIT-IORT for breast cancer confirmed that it is as effective as whole breast
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Abe M. History of
Intraoperative radiation therapy. In:Debelbower RR, Abe M (eds) Intraoperative radiation therapy. CRC, Boca Raton; :1-10, 1989.
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Kraus-Tiefenbacher, Uta; Bauer, Lelia; Scheda, Antonella; Schoeber, Carola; Schaefer, Joerg; Steil, Volker; Wenz, Frederik (14 September 2007).
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in controlling cancer, and also reduces deaths from other causes as shown in a large international randomised clinical trial published in the
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305:"Intraoperative radiotherapy in colorectal cancer: Systematic review and meta-analysis of techniques, long-term outcomes, and complications"
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503:"Targeted Intraoperative Radiotherapy Impairs the Stimulation of Breast Cancer Cell Proliferation and Invasion Caused by Surgical Wounding"
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Hannoun-Levi, Jean-Michel; Ihrai, Tarik; Courdi, Adel (November 2013). "Local treatment options for ipsilateral breast tumour recurrence".
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Mirnezami, Reza; Chang, George J.; Das, Prajnan; Chandrakumaran, Kandiah; Tekkis, Paris; Darzi, Ara; Mirnezami, Alexander H. (March 2013).
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354:"Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy"
201:, orthovoltage (250–300 kV) X-rays (X-ray IORT), high-dose-rate brachytherapy (HDR-IORT), or low-energy (50 kV) x-rays (low-energy IORT).
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Comptes rendus des séances du 3e Congrès international d'électrologie et de radiologie médicales (Milan: 5-9 septembre 1906)
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Hill, M. A. (15 December 2004). "The variation in biological effectiveness of X-rays and gamma rays with energy".
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158:. As a growing trend in recent years, IORT can also be used in earlier stage cancers such as prostate and
779:"Breast cancer breakthrough as new treatment requires one shot of radiotherapy instead of multiple doses"
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Abe, Mitsuyuki; Takahashi, Masaji (July 1981). "Intraoperative radiotherapy: The japanese experience".
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150:. IORT is typically a component in the multidisciplinary treatment of locally advanced and recurrent
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Goldson A., Past, present and prospects of intraoperative radiotherapy (IOR). Semin Oncol 1981.
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It may require cleanup to comply with
Knowledge (XXG)'s content policies, particularly
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Several methods are used to deliver IORT. IORT can be delivered using electron beams
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that is administered during surgery directly in the operating room (hence
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Report of AAPM Radiation
Therapy IORT Committee Task Group No. 72
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International
Journal of Radiation Oncology, Biology, Physics
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Intraoperative
Radiation Therapy in the Treatment of Cancer
692:(2nd ed.). New York: Humana Press. pp. 73–84.
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A major contributor to this article appears to have a
440:"Single-dose radiotherapy eases breast cancer stress"
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277:Intraoperative electron radiation therapy
142:levels of radiation are delivered to the
72:Learn how and when to remove this message
777:Correspondent, Maya Oppenheim, Health.
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558:(in French). Lille: C. Robbo. p.
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242:relative biological effectiveness
146:while the area is exposed during
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912:Intraoperative radiation therapy
901:Intraoperative radiation therapy
621:. Vol. 31. pp. 65–70.
125:Intraoperative radiation therapy
87:Intraoperative radiation therapy
52:. Please discuss further on the
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1010:Stereotactic radiation therapy
744:Radiation Protection Dosimetry
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1431: Also known as systemic
1267:Radiation-induced lung injury
520:10.1158/1078-0432.CCR-07-4453
1397:Radiation treatment planning
587:10.1016/0360-3016(81)90001-8
321:10.1016/j.suronc.2012.11.001
1382:Percentage depth dose curve
698:10.1007/978-1-61779-015-7_4
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690:Intraoperative Irradiation
552:Comas, C; Prio, A (1906).
417:10.1016/j.ctrv.2013.02.003
271:External beam radiotherapy
250:external beam radiotherapy
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1367:Oxygen enhancement ratio
1322:Dose verification system
507:Clinical Cancer Research
405:Cancer Treatment Reviews
371:10.1186/1471-2407-7-178
254:British Medical Journal
232:Low-energy IORT (50 kV)
1327:Dose-volume histogram
617:Vaeth, J. M. (1996).
438:Smyth, Chris (2014).
50:neutral point of view
1387:Radiation oncologist
1377:Pencil-beam scanning
1352:Multileaf collimator
1202:ibritumomab tiuxetan
1392:Radiation Therapist
1262:Radiation proctitis
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1197:Radioimmunotherapy
1001:Megavoltage X-rays
991:Superficial X-rays
954:Radiation oncology
815:has generic name (
756:10.1093/rpd/nch091
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857:10.1136/bmj.m2836
707:978-1-61779-014-0
636:978-3-8055-6456-4
627:10.1159/000061147
309:Surgical Oncology
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