IORT de cabeza y cuello

Tratamiento

Independientemente de la ubicación del tumor primario, la gran mayoría de los casos de recurrencia se producen en la localización del tumor original o en una zona adyacente. Por los efectos de la dispersión de la radiación que provocan los tratamientos convencionales de radioterapia para tumores de cabeza y cuello, el riesgo de dañar diversas estructuras anatómicas sensibles como, por ejemplo, los nervios, la aorta, los músculos o las cuerdas vocales es relativamente alto. La radioterapia intraoperatoria (IORT) permite administrar la radiación inmediatamente después de la resección quirúrgica y, por lo tanto, hacerlo directamente en el lecho tumoral, de modo que se reduce al mínimo la dispersión.^{1, 2, 3}

Pasos del tratamiento

Paso 1 Se localiza el tumor mediante diagnóstico por imagen.

Paso 2 El cirujano expone el tumor durante la incisión quirúrgica.

Paso 3 Se extirpa el tumor quirúrgicamente; los vasos y los nervios críticos se protegen del campo de tratamiento con instrumental quirúrgico.

Paso 4 Se selecciona el aplicador del tipo y tamaño adecuados y se coloca en el lecho tumoral.

Paso 5: El lecho tumoral se irradia localmente durante aproximadamente 30 minutos.

Paso 6 Se retira el aplicador, se vuelven a colocar las protecciones y las estructuras, y se cierra la incisión.

Bibliografía

Resumen bibliográfico

1. Tumores cerebrales

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2. Cáncer de mama

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Alvarado, M. D., Conolly, J., Park, C., Sakata, T., Mohan, A. J., Harrison, B. L., … Ozanne, E. M. (2014). Patient preferences regarding intraoperative versus external beam radiotherapy following breast-conserving surgery. Breast Cancer Research and Treatment, 143(1), 135-140.

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Armoogum, K., Parry, J., Mackay, C., Thompson, A., Vaidya, J., Ackland, C., … Munro, A. (2007). Measurement of Skin Dose from Very Low Energy X-rays during Partial Breast Irradiation. Clinical Oncology, 19(3), S23.

Benda, R. K., Yasuda, G., Sethi, A., Gabram, S. G. A., Hinerman, R. W., & Mendenhall, N. P. (2003). Breast boost: Are we missing the target? A dosimetric comparison of two boost techniques. Cancer, 97(4), 905-909.

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Elsberger, B., Romsauerova, A., Vinnicombe, S., Whelehan, P., Brown, D. C., Dewar, J. A., … Evans, A. (2014). Comparison of mammographic findings after intraoperative radiotherapy or external beam whole breast radiotherapy. European Journal of Surgical Oncology, 40(2), 163–167.

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Esserman, L. J., Alvarado, M. D., Howe, R. J., Mohan, A. J., Harrison, B., Park, C., … Ozanne, E. M. (2014). Application of a decision analytic framework for adoption of clinical trial results: Are the data regarding TARGIT-A IORT ready for prime time? Breast Cancer Research and Treatment, 144(2), 371-378.

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Keshtgar, M. R. S., Vaidya, J. S., Tobias, J. S., Wenz, F., Joseph, D., Stacey, C., … Baum, M. (2011). Targeted Intraoperative Radiotherapy for Breast Cancer in Patients in Whom External Beam Radiation Is Not Possible. International Journal of Radiation Oncology*Biology*Physics, 80(1), 31-38.

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Kraus-Tiefenbacher, U., Welzel, G., Brade, J., Hermann, B., Siebenlist, K., Wasser, K. S., … Wenz, F. (2010). Postoperative Seroma Formation After Intraoperative Radiotherapy Using Low-Kilovoltage X-Rays Given During Breast-Conserving Surgery. International Journal of Radiation Oncology*Biology*Physics, 77(4), 1140–1145 .

Lim, S. Z., Yong, W. S., Ho, G. H., Madhukumar, P., Wong, F. Y., Chua, E. T., … Ong, K. W. (2014). Early experience with INTRABEAM intra-operative radiotherapy in an Asian population. European Journal of Cancer, 50, S214–S215.

Malter, W., Kirn, V., Richters, L., Fridrich, C., Markiefka, B., Bongartz, R., … Kraemer, S. (2014). Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences. International Journal of Breast Cancer, 1–6.

Massa, M., Franchelli, S., Panizza, R., Massa, T. (2016). Is current clinical practice modified about intraoperative breast irradiation? Chinese Journal of Cancer Research, 28(2), 146–149.

Merdad, A. A., Bahadur, Y. A., Fawzy, E. E., Hassouna, A. H., Eltaher, M. M., Alghaithy, Z. K., … Constantinescu, C. T. (2013). Phase II study on the use of intraoperative radiotherapy in early breast cancer. Saudi Medical Journal, 34(11), 1133–8.

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Pan, L., Zheng, W., Ye, X., Chen, L., Ke, Y., Wan, M., … Zhang, X. (2014). A novel approach of INTRABEAM intraoperative radiotherapy for nipple-sparing mastectomy with breast reconstruction. Clinical Breast Cancer, 14(6), 435–441.

Picot, J., Copley, V., Colquitt, J. L., Kalita, N., Hartwell, D., Bryant, J. (2015). The INTRABEAM® photon radiotherapy system for the adjuvant treatment of early breast cancer: A systematic review and economic evaluation. Health Technology Assessment, 19(69), 1–190.

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Rivera, R., Banks, A., Casillas-Lopez, A., Rashtian, A., Lewinsky, B., Sheth, P., … Holmes, D. R. (2016). Targeted Intraoperative Radiotherapy for the Management of Ductal Carcinoma In Situ of the Breast. The Breast Journal, 22(1), 63–74.

Ruano-Ravina, A., Cantero-Muñoz, P., Eraso Urién, A. (2011). Efficacy and safety of intraoperative radiotherapy in breast cancer: A systematic review. Cancer Letters, 313(1), 15–25.

Sedlmayer, F., Reitsamer, R., Wenz, F., Sperk, E., Fussl, C., Kaiser, J., … Fastner, G. (2017). Intraoperative radiotherapy (IORT) as boost in breast cancer. Radiation Oncology, 12(1), 23.

Sedlmayer, F., Zehentmayr, F., Fastner, G. (2013). Partial breast re-irradiation for local recurrence of breast carcinoma: Benefit and long term side effects. The Breast, 22, S141–S146.

Sperk, E., Welzel, G., Keller, A., Kraus-Tiefenbacher, U., Gerhardt, A., Sütterlin, M., Wenz, F. (2012). Late radiation toxicity after intraoperative radiotherapy (IORT) for breast cancer: results from the randomised phase III trial TARGIT A. Breast Cancer Research and Treatment, 135(1), 253-260.

Sperk, E., Astor, D., Keller, A., Welzel, G., Gerhardt, A., Tuschy, B., … Wenz, F. (2014). A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer. Radiation Oncology, 9(1), 154.

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Wasser, K., Schoeber, C., Kraus-Tiefenbacher, U., Bauer, L., Brade, J., Teubner, J., … Neff, W. (2007). Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer. European Radiology, 17(7), 1865–74.

Welzel, G., Blank, E., Kraus-Tiefenbacher, U., Keller, A., Vorodi, F., Herskind, C., … Wenz, F. K. (2008). The influence of the interval between IORT during breast-conserving surgery and external beam radiotherapy (EBRT) on late toxicity. Journal of Clinical Oncology, 26, 630.

Welzel, G., Boch, A., Sperk, E., Hofmann, F., Kraus-Tiefenbacher, U., Gerhardt, A., … Wenz, F. (2013). Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomised phase III trial TARGIT-A. Radiation Oncology, 8(1), 9.

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Williams, N. R., Pigott, K. H., Brew-Graves, C., Keshtgar, M. R. S. (2014). Intraoperative radiotherapy for breast cancer. Gland Surgery, 3(2), 109–119.

3. Tumores gastrointestinales

Algur, E., Mahadevan, A., Deibel, C. (2005). Interstitial photon radiosurgery system for re-current and locally advanced rectal cancer: a retrospective review of 24 patients. ASCO Gastrointestinal Cancers Symposium, Jan 27–29, Hollywood, Florida, USA, Abstract No 208.

Brady, J. T., Crawshaw, B.T., Crawshaw, B. P., Murrell, B., Dosokey, E. M. G., Jabir, M. A., Steele, S. R., … Reynolds, H. L. (2017). Influence of intraoperative radiation therapy on locally advanced and recurrent colorectal tumors: A 16-year experience. The American Journal of Surgery.

Guo, S., Reddy, C. A., Kolar, M., Woody, N., Mahadevan, A., Deibel, F., … Suh, J. H. (2012). Intraoperative radiation therapy with the photon radiosurgery system in locally advanced and recurrent rectal cancer: retrospective review of the Cleveland clinic experience. Radiation Oncology, 7(1), 110.

Haddock, M. G. (2016). Irradiation of Very Locally Advanced and Recurrent Rectal Cancer. Seminars in Radiation Oncology, 26(3), 226–235.

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Lyadov, K., Krymskiy, V., Markin, A., Krymskiy, A. (2008). Evaluation of safety of intraoperative radiotherapy using the intra beam system in combined treatment of gastric cancer. Poster Abstract Presented at the ISIORT Meeting.

Lyadov, K., Yu, S., Krymskiy, V., Krymskiy, A. (2008). Improvement of Curativity of Video-Assisted Surgery for Colorectal Cancer Due to Intra-Operative Contact Radiotherapy Using the INTRA BEAM System. ISIORT.

National Comprehensive Cancer Network® - Guidelines for Colon & Rectal Cancer, 2016

Polkowski, W. P., Skórzewska, M. (2014). Intraoperative Radiotherapy with Low-Energy Photons in Rectal Cancer Recurrence. (M. Keshtgar, K. Pigott, & F. Wenz, Eds.), Targeted Intraoperative Radiotherapy in Oncology. Berlin, Heidelberg: Springer Berlin Heidelberg.

Potemin, S., Uvarov, I., Vasilenko, I. (2015). Intraoperative radiotherapy in locally-advanced and recurrent rectal cancer: retrospective review of 68 cases. Transl Cancer Res, 4(2), 189–195.

Skórzewska, M., Mielko, J., Kurylcio, A., Romanek, J., Polkowski, W. P. (2016). Intraoperative radiotherapy with low energy photons in recurrent colorectal cancer: a single centre retrospective study. Współczesna Onkologia, 20(1), 52–57.

Susko, M., Lee, J., Salama, J., Thomas, S., Uronis, H., Hsu, D., … Palta, M. (2016). The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer. Annals of Surgical Oncology.

4. Tumores de cabeza y cuello

Abo-Madyan, Y., Gößler, U., Vent, J., Nwankwo, C., Schneider, F., Hörmann, K., Wenz, F. (2013). Intraoperative Radiotherapie for recurrent Head & Neck Squamous Cell Carcinoma using a mobile 50kV mini accelerator. DEGRO 2013, Poster.

Chen, A. M., Bucci, M. K., Singer, M. I., Garcia, J., Kaplan, M. J., Chan, A. S., Phillips, T. L. (2007). Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience. International Journal of Radiation Oncology*Biology*Physics, 67(1), 122-129.

De Felice, F., Musio, D., Tombolini, V. (2016). Intraoperative radiation therapy (IORT) in recurrent head and neck cancer. Oral Oncology, 55(marzo), e1.

Kyrgias, G., Hajiioannou, J., Tolia, M., Kouloulias, V., Lachanas, V., Skoulakis, C., … Bizakis, I. (2016). Intraoperative radiation therapy (IORT) in head and neck cancer: A systematic review. Medicine, 95(50), e5035.

Münter, M. W., Köppen, U., Ramuscak, A., Sittel, C., Wegner, N. (2015). Intraoperative radiotherapy (IORT) in the treatment of head and neck cancer. Transl Cancer Res, 4(2), 178–181.

Roopashri, G., Baig, M. (2013). Current advances in radiotherapy of head and neck malignancies. Journal of International Oral Health, 5(6), 119–23.

Rutkowski, T., Wygoda, A., Hutnik, M., Składowski, K., Wydmański, J., Maciejewski, A., … Maciejewski, B. (2010). Intraoperative Radiotherapy (IORT) with Low-Energy Photons as a Boost in Patients with Early-Stage Oral Cancer with the Indications for Postoperative Radiotherapy. Strahlentherapie Und Onkologie, 186(9), 496–501.

5. Cáncer de piel no melanomatoso

Amini, S., Viera, M. H., Valins, W., Berman, B. (2010). Nonsurgical innovations in the treatment of nonmelanoma skin cancer. The Journal of Clinical and Aesthetic Dermatology, 3(6), 20–34.

Armoogum, K., Parry, J., Mackay, C., Thompson, A., Vaidya, J., Ackland, C., … Munro, A. (2007). Measurement of Skin Dose from Very Low Energy X-rays during Partial Breast Irradiation. Clinical Oncology, 19(3), S23.

Bhatnagar, A., Loper, A. (2010). The initial experience of electronic brachytherapy for the treatment of non-melanoma skin cancer. Radiation Oncology (Londres, Reino Unido), 5, 87.

Chan, S., Dhadda, A.S. (2007) Swindell, R., Single fraction radiotherapy for small superficial carcinoma of the skin. Clin Oncol (R Coll Radiol), 19(4), 256-9.

Cognetta, A. B., Howard, B. M., Heaton, H. P., Stoddard, E. R., Hong, H. G., Green, W. H. (2012). Superficial x-ray in the treatment of basal and squamous cell carcinomas: a viable option in select patients. Journal of the American Academy of Dermatology, 67(6), 1235–41.

Bodner, W. R., Hilaris, B. S., Alagheband, M., Safai, B., Mastoras, C. A., Saraf, S. (2003). Use of low-energy X-rays in the treatment of superficial nonmelanomatous skin cancers. Cancer Investigation, 21(3), 355–362.

Ducassou, A. (2015). First experience of skin treatments with INTRABEAM at IUCT Oncopole Toulouse. In ESTRO proceeding.

Ermertcan, A. T., Hellings, P. W., Cingi, C. (2012). Nonmelanoma skin cancer of the head and neck: nonsurgical treatment. Facial Plastic Surgery Clinics of North America, 20(4), 445–54.

Goubert, M., Parent, L. (2015). Dosimetric characterization of INTRABEAM® miniature accelerator flat and surface applicators for dermatologic applications. Physica Medica, 31(3), 224–232.

Jankarashvili, N., Topeshashvili, M. (2015). Treatment of skin cancer with intrabeam. 9th ZEISS INTRABEAM User Meeting.

Levell, N. J., Igali, L., Wright, K. A., Greenberg, D. C. (2013). Basal cell carcinoma epidemiology in the UK: the elephant in the room. Clinical and Experimental Dermatology, 38(4), 367–9.

Nguyen, T. H., Ho, D. Q.-D. (2002). Nonmelanoma skin cancer. Current Treatment Options in Oncology, 3(3), 193–203.

Perkins, J. L., Liu, Y., Mitby, P. A., Neglia, J. P., Hammond, S., Stovall, M., … Mertens, A. C. (2005). Nonmelanoma skin cancer in survivors of childhood and adolescent cancer: a report from the childhood cancer survivor study. Journal of Clinical Oncology, 23(16), 3733–41.

Tward, J.D., Anker, C, J,. Gaffney, D.K., Bowen, G. . (2012). Radiation Therapy and Skin Cancer. Modern Practices in Radiation Therapy, 207–246.

6. Metástasis vertebrales

Berenson, J., Pflugmacher, R., ..., Jarzem, P. (2011) Cancer Patient Fracture Evaluation (CAFE) lnvestigators. Cifoplastia con balón frente al tratamiento no quirúrgico de fracturas vertebrales por compresión dolorosas en pacientes con cáncer: un ensayo clínico aleatorizado multicentro. Lancet Oncology, 12(3), 225-35.

Bludau, F., Obertacke, U., Schmidt, R. (2012). First middle-term results after Kypho-IORT. European Spine Journal, 21(11), 2332.

Bludau, F. (2014). Kypho-IORT: Intraoperative Radiotherapy in Spinal Metastases: Nine-Month Clinical Results. The Spine Journal, 14(11), S163

Bludau, F., Reis, T., Schneider, F., Clausen, S., Wenz, F., Obertacke, U. (2015). Kyphoplastie kombiniert mit intraoperativer Radiotherapie (Kypho-IORT). Der Radiologe, 55(10), 859–867.

Kayser, R., Ender, S. A., Asse, E., Wilhelm, E., Adler, F., Schmidt, R., … Bludau, F. (2013). Kyphoplastie in Kombination mit intraoperativer Radiotherapie. Der Orthopäde, 42(9), 765–771.

Miglierini, P., Dam-Hieu, P., Key, S. (2014). Kypho-IORT: the first French treatment. Translational Cancer Research, 3(1).

Reis, T., Schneider, F., Hermann, B., Bohrer, M., Schmitt, R., Obertacke, U., Wenz, F. (2010). Kypho-IORT: A novel treatment of spinal metastases with intraoperative radiotherapy during kyphoplasty. International Journal of Radiation Oncology Biology Physics, 78(3), S581–S582.

Reis, T., Schneider, F., Welzel, G., Schmidt, R., Bludau, F., Obertacke, U., Wenz, F. (2012). Intraoperative radiotherapy during kyphoplasty for vertebral metastases (Kypho-IORT): first clinical results. Tumori, 98(4), 434–40.

Reis, T., Sperk, E., Schneider, F., Schmidt, R., Obertacke, U., Wenz, F. (2012). Kypho-IORT for spinal metastasis: a case study. Hospital Oncology & Haematology Europe, Campden Publishing Ltd, Apr, 21-24.

Schmidt, R., Obertacke, U., Wenz, F., Reis, T., Schneider, F. (2010). Clinical feasibility of a new minimal invasive intraoperative radiation in combination with balloon kyphoplasty (Kypho-IORT) for spinal metastases. European Spine Journal, 19(11), 2049.

Schmidt, R., Wenz, F., Reis, T., Janik, K., Bludau, F., Obertacke, U. (2012). Kyphoplasty and intra-operative radiotheray, combination of kyphoplasty and intra-operative radiation for spinal metastases: technical feasibility of a novel approach. International Orthopaedics, 36(6), 1255–1260.

Schneider, F., Greineck, F., Clausen, S., Mai, S., Obertacke, U., Reis, T., Wenz, F. (2011). Development of a Novel Method for Intraoperative Radiotherapy During Kyphoplasty for Spinal Metastases (Kypho-IORT). International Journal of Radiation Oncology*Biology*Physics, 81(4), 1114-1119.

Wenz, F., Schneider, F., Neumaier, C., Kraus-Tiefenbacher, U., Reis, T., Schmidt, R., Obertacke, U. (2010). Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases. Radiation Oncology, 5(1), 11.

7. Física médica

Armoogum, K. S., Parry, J. M., Souliman, S. K., Sutton, D. G., Mackay, C. D. (2007). Functional intercomparison of intraoperative radiotherapy equipment - Photon Radiosurgery System. Radiation Oncology, 2(1), 11.

Eaton, D. J., Duck, S. (2010). Dosimetry measurements with an intra-operative x-ray device. Physics in Medicine and Biology, 55(12), N359–N369.

Eaton, D. J., Gonzalez, R., Duck, S., Keshtgar, M. (2011). Radiation protection for an intra-operative X-ray device. The British Journal of Radiology, 84(1007), 1034–1039.

Eaton, D. J., Best, B., Brew-Graves, C., Duck, S., Ghaus, T., Gonzalez, R., … Keshtgar, M. R. S. (2012). In Vivo Dosimetry for Single-Fraction Targeted Intraoperative Radiotherapy (TARGIT) for Breast Cancer. International Journal of Radiation Oncology*Biology*Physics, 82(5), e819–e824.

Eaton, D. J. (2012). Quality assurance and independent dosimetry for an intraoperative x-ray device. Medical Physics, 39(11), 6908.

Ebert, M. A., Asad, A. H., Siddiqui, S. A. (2009). Suitability of radiochromic films for dosimetry of very-low energy X-rays. Journal of Applied Clinical Medical Physics / American College of Medical Physics, 10(4), 2957.

Cardoso, M. J., Cardoso, J. S., Oliveira, H. P., Gouveia, P. (2016). The breast cancer conservative treatment. Cosmetic results – BCCT.core – Software for objective assessment of esthetic outcome in breast cancer conservative treatment: A narrative review. Computer Methods and Programs in Biomedicine, 126, 154–159.

Chiavassa, S., Buge, F., Hervé, C., Delpon, G., Rigaud, J., Lisbona, A., Supiot, S. (2015). Monte Carlo evaluation of the effect of inhomogeneities on dose calculation for low energy photons intra-operative radiation therapy in pelvic area. Physica Medica, 31(8), 956–962.

Darby, S. C., Ewertz, M., McGale, P., Bennet, A. M., Blom-Goldman, U., Brønnum, D., … Hall, P. (2013). Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer. New England Journal of Medicine, 368(11), 987–998.

Eaton, D. J., Earner, B., Faulkner, P., Dancer, N. (2013). A national dosimetry audit of intraoperative radiotherapy. The British Journal of Radiology, 86(1032), 20130447.

Emami, B., Woloschak, G., Small Jr, W. (2015). Beyond the linear quadratic model : intraoperative radiotherapy and normal tissue tolerance. Transl Cancer Res, 4(2), 140–147.

Goubert, M., Parent, L. (2015). Dosimetric characterization of INTRABEAM^® miniature accelerator flat and surface applicators for dermatologic applications. Physica Medica, 31(3), 224–232.

Härtl, P. M., Dobler, B., Kölbl, O., Treutwein, M. (2009). Praktische Dosimetrie und Konstanzprüfung zur Einführung der intraoperativen Bestrahlung mit Intrabeam^®(Zeiss). Zeitschrift Für Medizinische Physik, 19(4), 288–293.

Hill, R., Healy, B., Holloway, L., Kuncic, Z., Thwaites, D., Baldock, C. (2014). Advances in kilovoltage x-ray beam dosimetry. Physics in Medicine and Biology, 59(6), R183–R231.

Keshtgar, M. R. S., Williams, N. R., Bulsara, M., Saunders, C., Flyger, H., Cardoso, J. S., … Joseph, D. J. (2013). Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Research and Treatment, 140(3), 519-525.

Xu, Y., & Lam, S. (2013). Dosimetric Characteristic of Zeiss IntraBeam Flat and Surface Applicators. Medical Physics, 40(6), 284–284.

Lam, S. C. P., Xu, Y., West, M. (2016). Shielding Effects on Low-KVIORT Forward Projecting Applicators. EC Cancer, 2(1), 64–75.

Muralidhar, K. R., Rout, B., Mallikarjuna, A., Poornima, A., Murthy, P. N. (2014). Commissioning and quality assurances of the Intrabeam Intra-Operative radiotherapy unit. International Journal of Cancer Therapy and Oncology, 2(4), 20415.

Nwankwo, O., Clausen, S., Schneider, F., Wenz, F. (2013). A virtual source model of a kilo-voltage radiotherapy device. Physics in Medicine and Biology, 58(7), 2363–2375.

Preuss, J., Lester, L., Saunders, C. (2012). BCCT.core – Can a computer program be used for the assessment of aesthetic outcome after breast reconstructive surgery? The Breast, 21(4), 597–600.

Price, C., Pederson, A., Frazier, C., Duttenhaver, J. (2013). In vivo dosimetry with optically stimulated dosimeters and RTQA2 radiochromic film for intraoperative radiotherapy of the breast. Medical Physics, 40(9), 91716.

Schneider, F., Clausen, S., Jahnke, A., Steil, V., Bludau, F., Sütterlin, M., … Wenz, F. (2014). Radiation protection for an intraoperative X-ray source compared to C-arm fluoroscopy. Zeitschrift Fur Medizinische Physik, 24(3), 243–251.

Schneider, F., Clausen, S., Thölking, J., Wenz, F., Abo-Madyan, Y. (2014). A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report. Journal of Applied Clinical Medical Physics / American College of Medical Physics, 15(1), 4502.

Sethi, A., Chinsky, B., Gros, S., Diak, A. (2015). Tissue inhomogeneity corrections in low-kV intra-operative radiotherapy (IORT). Translational Cancer Research, 4(2), 182–188.

Steenbeke, F., Gevaert, T., Tournel, K., Engels, B., Verellen, D., Storme, G., Ridder, M. D. (2015). Quality Assurance of a 50-kV Radiotherapy Unit Using EBT3 GafChromic Film: A Feasibility Study. Technology in Cancer Research & Treatment, 15(1), 163–70.

Watson, P. G. F., Seuntjens, J. (2016). Technical Note: Effect of explicit M and N-shell atomic transitions on a low-energy x-ray source. Medical Physics, 43(4), 1760–1763.

Wuu, C.-S., Sheu, R.-D., Chen, J. (2015). Microdosimetric characteristics of 50 kV X rays at different depths for breast intraoperative radiotherapy. Radiation Protection Dosimetry, 166(1–4), 343–6.

8. Radiobiología

Belletti, B., Vaidya, J. S., D’Andrea, S., Entschladen, F., Roncadin, M., Lovat, F., … Massarut, S. (2008). Targeted Intraoperative Radiotherapy Impairs the Stimulation of Breast Cancer Cell Proliferation and Invasion Caused by Surgical Wounding. Clinical Cancer Research, 14(5), 1325–1332.

Fabris, L., Berton, S., Citron, F., D’Andrea, S., Segatto, I., Nicoloso, M. S., … Belletti, B. (2016). Radiotherapy-induced miR-223 prevents relapse of breast cancer by targeting the EGF pathway. Oncogene, (febrero de 2016), 1–13.

Herskind, C., Griebel, J., Kraus-Tiefenbacher, U., Wenz, F. (2008). Sphere of Equivalence—A Novel Target Volume Concept for Intraoperative Radiotherapy Using Low-Energy X Rays. International Journal of Radiation Oncology*Biology*Physics, 72(5), 1575-1581.

Herskind, C., Ma, L., Liu, Q., Zhang, B., Schneider, F., Veldwijk, M. R., & Wenz, F. (2017). Biology of high single doses of IORT: RBE, 5 R’s, and other biological aspects. Radiation Oncology (London, England), 12(1), 24.

Herskind, C., Schalla, S., Hahn, E. W., Höver, K.-H., ..., Wenz, F. (2006). "Influence of different dose rates on cell recovery and RBE at different spatial positions during protracted conformal radiotherapy." Radiation protection dosimetry, 122 (1-4), 498-505.

Herskind, C., Wenz, F. (2010). Radiobiological Comparison of Hypofractionated Accelerated Partial-Breast Irradiation (APBI) and Single-Dose Intraoperative Radiotherapy (IORT) with 50-kV X-Rays. Strahlentherapie Und Onkologie, 186(8), 444–451.

Herskind, C., Wenz, F. (2014). Radiobiological aspects of intraoperative tumour-bed irradiation with low-energy X-rays ( LEX-IORT ). Transl Cancer Res, 3(1), 3–17.

Liu, Q., Schneider, F., Ma, L., Wenz, F., Herskind, C. (2013). Relative Biologic Effectiveness (RBE) of 50 kV X-rays Measured in a Phantom for Intraoperative Tumor-Bed Irradiation. International Journal of Radiation Oncology*Biology*Physics, 85(4), 1127-1133.

Minafra, L., & Bravatà, V. (2014). Cell and molecular response to IORT treatment. Translational Cancer Research, 3(1), 32–47.
Sologuren, I., Rodríguez-gallego, C., & Lara, P. C. (2014). Immune effects of high dose radiation treatment: implications of ionizing radiation on the development of bystander and abscopal effects. Transl Cancer Res, 3(1), 18–31.
Woolf, D. K., Williams, N. R., Bakshi, R., Madani, S. Y., Eaton, D. J., Fawcitt, S., … Keshtgar, M. (2014). Biological dosimetry for breast cancer radiotherapy: a comparison of external beam and intraoperative radiotherapy. SpringerPlus, 3, 329.

9. Calidad de vida y resultados estéticos

Coombs, N. J., Coombs, J. M., Vaidya, U. J., Singer, J., Bulsara, M., Tobias, J. S., … Vaidya, J. S. (2016). Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT. BMJ Open, 6(5).

Corica, T., Joseph, D., Saunders, C., Bulsara, M., Nowak, A. K. (2014). Intraoperative radiotherapy for early breast cancer: do health professionals choose convenience or risk? Radiation Oncology, 9(1), 1–9.

Corica, T., Nowak, A. K., Saunders, C. M., Bulsara, M., Taylor, M., Vaidya, J. S., … Joseph, D. J. (2016). Cosmesis and Breast-Related Quality of Life Outcomes After Intraoperative Radiation Therapy for Early Breast Cancer: A Substudy of the TARGIT-A Trial. International Journal of Radiation Oncology*Biology*Physics, 96(1), 55-64.

Cardoso, M. J., Cardoso, J. S., Oliveira, H. P., Gouveia, P. (2016). The breast cancer conservative treatment. Cosmetic results – BCCT.core – Software for objective assessment of esthetic outcome in breast cancer conservative treatment: A narrative review. Computer Methods and Programs in Biomedicine, 126, 154–159.

Cracco, S., Semprini, G., Cattin, F., Gregoraci, G., Zeppieri, M., Isola, M., … Parodi, P. C. (2015). Impact of Intraoperative Radiotherapy on Cosmetic Outcome and Complications after Oncoplastic Breast Surgery. The Breast Journal, 21(3), 285–290

Keshtgar, M. R. S., Williams, N. R., Bulsara, M., Saunders, C., Flyger, H., Cardoso, J. S., … Joseph, D. J. (2013). Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Research and Treatment, 140(3), 519-525.

Massa, M., Meszaros, P., Baldelli, I., Bisso, N., Franchelli, S. (2015). Aesthetic evaluation in oncoplastic and conservative breast surgery: a comparative analysis. Plast Reconstr Surg Glob Open, 3(3), e339.

Ng, J., Dai, T. (2016). Radiation therapy and the abscopal effect: a concept comes of age. Annals of Translational Medicine, 4(6), 118–118.

Soror, T., Kovács, G., Kovács, Á., Seibold, N., Melchert, C., Baumann, K., … Stojanovic-Rundic, S. (2016). New objective method in reporting the breast cosmesis after breast-conservative treatment based on nonstandardized photographs: The Objective Breast Cosmesis Scale. Brachytherapy, [Epub].

Welzel, G., Hofmann, F., Blank, E., Kraus-Tiefenbacher, U., Hermann, B., Sütterlin, M., Wenz, F. (2010). Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays. Annals of Surgical Oncology, 17(S3), 359–367.

Yu, T., Eom, K. Y., Jang, N. Y., Kim, K. S., Koo, T.S., Koo, T. R., Kwon, J., … Kim, I. A. (2016). Objective measurement of cosmetic outcomes of breast conserving therapy using BCCT.core. Cancer Research and Treatment, 48(2), 491–498.

10. IORT General

Biggs, D. S., Thomson, E. S. (1996). Radiation properties of a miniature X-ray device for radiosurgery. The British Journal of Radiology, 69(822), 544–7.

Calvo, F. A. (2017). Intraoperative irradiation: precision medicine for quality cancer control promotion. Radiation Oncology, 12(1), 36.
Calvo, F. A., Sole, C. V, González, M. E., Tangco, E. D., López-Tarjuelo, J., Koubychine, I., … Ferrer, C. (2013). Research opportunities in intraoperative radiation therapy: the next decade 2013–2023. Clinical and Translational Oncology, 15(9), 683–690.

Coles, C. E., Yarnold, J. R. (2016). Accelerated partial breast irradiation: the new standard? The Lancet, 387(10015), 201-202.

Debenham, B. J., Hu, K. S., Harrison, L. B. (2013). Present status and future directions of intraoperative radiotherapy. The Lancet Oncology, 14(11), e457–e464.

Eaton, D. J. (2015). Electronic brachytherapy—current status and future directions. The British Journal of Radiology, 88(1049), 20150002.

Holmes, D. R. (2015). Intraoperative Radiotherapy of the Breast for Early-Stage Breast Cancer: Ready for Primetime. The Breast Journal, 21(2), 181–184.

Mooney, H. (2014). NICE gives go ahead to intrabeam radiotherapy for breast cancer. BMJ, 349(jul28 6), g4863–g4863.

Kalakota, K., Small, W. (2014). Intraoperative radiation therapy techniques and options for breast cancer. Expert Review of Medical Devices, 11(3), 265–73.

Paolo, V., De Lorenzi Francesca, Pietro, L., Mario, R., Umberto, V. (2016). Current Trends in the Oncologic and Surgical Managements of Breast Cancer in Women with Implants: Incidence, Diagnosis, and Treatment. Aesthetic Plastic Surgery, 40(2), 256–265.

Thariat, J., Hannoun-Levi, J.-M., Sun Myint, A., Vuong, T., Gérard, J.-P. (2012). Past, present, and future of radiotherapy for the benefit of patients. Nature Reviews Clinical Oncology, 10(1), 52–60.

Tobias, J. S., Vaidya, J. S., Keshtgar, M., D’Souza, D. P., Baum, M. (2004). Reducing radiotherapy dose in early breast cancer: the concept of conformal intraoperative brachytherapy. The British Journal of Radiology, 77(916), 279–84.

11. Directrices

AGO. (2014). Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer, Guidelines(Ver. 1).

Aetna. (2015). Intraoperative Radiation Therapy (IORT).

DEGRO. (n.d.). Leitlinie zur Weiterbildung zum Facharzt für Strahlentherapie.

Gnant, M., Harbeck, N., Thomssen, C. (2011). St. Gallen 2011: Summary of the consensus discussion. Breast Care, 6(2), 136–141.

Goldhirsch, A., Wood, W. C., Coates, A. S., Gelber, R. D., Thürlimann, B., Senn, H. J. (2011). Strategies for subtypes-dealing with the diversity of breast cancer: Highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2011. Annals of Oncology, 22(8), 1736–1747.

NCCN. (2015). NCCN Clinical Practice Guidelines in Oncology - Breast Cancer.

NCCN. (2016). NCCN Clinical Practice Guidelines in Oncology - Colon Cancer.

NCCN. (2016). NCCN Clinical Practice Guidelines in Oncology - Rectal Cancer.

Polgár, C., Limbergen, E. Van, Pötter, R., Kovács, G., Polo, A., Lyczek, J., … Strnad, V. (2010). Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: Recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group. Radiotherapy and Oncology, 94(3), 264–273.

Sedlmayer, F., Sautter-Bihl, M. L., Budach, W., Dunst, J., Fastner, G., Feyer, P., … Sauer, R. (2013). DEGRO practical guidelines: Radiotherapy of breast cancer I: Radiotherapy following breast conserving therapy for invasive breast cancer. Strahlentherapie Und Onkologie, 189(10), 825–833.

Smith, B. D., Arthur, D. W., Buchholz, T. A., Haffty, B. G., Hahn, C. A., Hardenbergh, P. H., … Harris, J. R. (2009). Accelerated Partial Breast Irradiation Consensus Statement From the American Society for Radiation Oncology (ASTRO). International Journal of Radiation Oncology*Biology*Physics, 74(4), 987-1001.

12. Ensayos clínicos

Institut du Cancer de Montpellier - Val d'Aurelle. Feasibility Clinical Trial of Intraoperative Radiotherapy (IORT) and Second Breast-conserving-surgery After Local Recurrence of Breast Carcinoma. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02386371.

Liao Ning. Intra-operative Radiotherapy For Women With Ductal Carcinoma in Situ Breast Cancer After Nipple-sparing Mastectomy. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02389686.

Liao Ning. Intra-operative Radiotherapy After Breast-conversing Surgery in Treating Women With Ductal Carcinoma in Situ Breast Cancer. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02389673.

Loyola University. Combining Intraoperative Radiotherapy With Kyphoplasty for Treatment of Spinal Metastases. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02480036.

Loyola University. Phase I Study of Low Kilovoltage Intraoperative Radiation for Patients With Resectable Pancreatic Adenocarcinoma. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Jul 14]. NLM Identifier: NCT02599662

Universitätsmedizin Mannheim. A Multicenter Randomised Phase III Trial on INTraoperative RAdiotherapy in Newly Diagnosed GliOblastoma Multiforme (INTRAGO II). In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02685605.

Universitätsmedizin Mannheim. INTRAGO-Intraoperative Radiotherapy for Glioblastoma - a Phase I/II Study. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02104882.

Universitätsmedizin Mannheim. Intraoperative Radiotherapy During Kyphoplasty/Vertebroplasty (Kypho-IORT) Versus EBRT in the Treatment of Painful Vertebral Metastases - a Randomised Prospective Phase III Study -. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Jul 14]. NLM Identifier: NCT02773966.

Universitätsmedizin Mannheim. TARGIT-C(Consolidation) Prospective Phase IV Study of Intraoperative Radiotherapy (IORT) in Patients With Small Breast Cancer. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02290782.

Universitätsmedizin Mannheim. TARGeted Intraoperative radioTherapy With the INTRABEAM-System as an Advanced Boost in Patients With Breast Cancer - A Quality Control Registry in Germany (TARGIT BQR). In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT01440010.

University College, London. An International Randomised Controlled Trial to Compare Targeted Intra-operative Radiotherapy Boost With Conventional External Beam Radiotherapy Boost After Lumpectomy for Breast Cancer in Women With a High Risk of Local Recurrence.An International Randomised Controlled Trial to Compare Targeted Intra-operative Radiotherapy Boost With Conventional External Beam Radiotherapy Boost After Lumpectomy for Breast Cancer in Women With a High Risk of Local Recurrence. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT01792726.

University of California, San Francisco. Targeted Intraoperative Radiotherapy United States (TARGIT-US) Phase IV Registry Trial: A Registry Trial of Targeted Intraoperative Radiation Therapy Following Breast-conserving Surgery. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT01570998.

University of Dundee. Intraoperative Radiotherapy (IORT) for Rectal Cancer Using the Photon Radiosurgery System (PRS): A Phase I Clinical Trial. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT00910494.

Biblioteca de medios

Productos

IORT de ZEISS

Obtenga más información sobre el cáncer y las ventajas de la radioterapia (IORT) en el tratamiento de esta enfermedad. Conozca la amplia gama de indicaciones oncológicas a las que ZEISS da servicio y cómo puede beneficiarse su práctica de radioterapia con la técnica IORT de ZEISS.

INTRABEAM 600 de ZEISS - El sistema de tercera generación

Como equipo de tercera generación de IORT de ZEISS, el nuevo sistema INTRABEAM 600 es la primera plataforma totalmente integrada y conectada para IORT que responde a diversas necesidades clínicas en una solución única.

Funcionamiento de la fuente de rayos X (XRS) del sistema INTRABEAM ^® de ZEISS

En este vídeo se describen los componentes y el funcionamiento del XRS. Vea qué sucede en el equipo de XRS durante el tratamiento IORT.

Indicaciones

Funcionamiento de la técnica IORT para el tratamiento del cáncer de mama

Este vídeo muestra una intervención quirúrgica conservadora (BCS) con IORT y describe los distintos pasos del procedimiento durante el tratamiento.

Funcionamiento de la técnica Kypho-IORT para el tratamiento de metástasis vertebrales

Este vídeo muestra los pasos de la aplicación de la técnica Kypho-IORT en el tratamiento de pacientes con metástasis vertebrales.

Funcionamiento de la técnica IORT con vertebroplastia en el tratamiento de metástasis vertebrales

Este vídeo muestra los pasos del procedimiento de la técnica combinada de vertebroplastia con IORT en el tratamiento de pacientes con metástasis vertebrales.

^{* El Sistema INTRABEAM de ZEISS está formado por: INTRABEAM PRS 500 con XRS, carro INTRABEAM y soporte INTRABEAM NC32}

Tumores de cabeza y cuello