Newest ESTRO and NCCN Guidelines about IOeRT in 2020
April 2020: „...Intraoperative radiation therapy (IORT) is a very precise sub-component of RT that can intensify the irradiation effect forcancer involving an anatomically well-defined volume, generally delivered with electrons (IOERT) ... Long-term survivors were observedamong unresected patients treated with external beam RT and an IOERT boost (OS 6% at 3 years; 3% >5 years). Improvement of localcontrol through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted asset in the clinical scenario ... and extremely accurate in terms of dose-deposit characteristics and normal tissue sparing. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend the use of IOERT in cases of close surgical margins and residual disease.
Reference: thegreenjournal.com/article/S0167-8140(20)30174-2/pdf
Reference: thegreenjournal.com/article/S0167-8140(20)30174-2/pdf
University of Heidelberg clinic confirms advantages of IOeRT in 2020:
Advantages of IOeRT according to German clinic study:
Reference: https://www.frontiersin.org/articles/10.3389/fonc.2019.00384/full
- "...direct visualization of the tumor bed"
- "...better skin sparing"
- "...less inter- and intrafractional motion"
- "...radiobiological effects may be beneficial..."
Reference: https://www.frontiersin.org/articles/10.3389/fonc.2019.00384/full
„IOERT has the longest evidence of all IORT techniques...
...creating enourmous advantage in treatmentcomfort for the patient.“
Juli 2018: ioERT (intraoperative electron radiotherapy) in breast cancer is used either as a boost (10–12 Gy) followed by whole breastirradiation (WBI) or as full-dose partial breast irradiation (PBI, 20–24 Gy) during breast-conserving surgery. ... When administered as a boost, excellent low local recurrence rates were observed in long-term follow-up >5 years.... IOERT prolongs the surgical procedure to a small degree; however, it shortens or, in special cases with a low risk of recurrence, even replaces adjuvant radiotherapy, ...
Reference: ncbi.nlm.nih.gov/pmc/articles/PMC6062668/
Juli 2018: ioERT (intraoperative electron radiotherapy) in breast cancer is used either as a boost (10–12 Gy) followed by whole breastirradiation (WBI) or as full-dose partial breast irradiation (PBI, 20–24 Gy) during breast-conserving surgery. ... When administered as a boost, excellent low local recurrence rates were observed in long-term follow-up >5 years.... IOERT prolongs the surgical procedure to a small degree; however, it shortens or, in special cases with a low risk of recurrence, even replaces adjuvant radiotherapy, ...
Reference: ncbi.nlm.nih.gov/pmc/articles/PMC6062668/
ASTRO Society statement...
“IORT with electrons (IOeRT) can be used in the clinical practice outside of a clinical trial for the suitable group of patient...” und warnt weiter vor dem Einsatz von Röntgen: „...wewould like to address our concerns specifically regarding the recommendations on the use of low-energy x-ray intraoperative radiationtherapy (IORT).“
Reference: practicalradonc.org/article/S1879-8500(17)30043-7/abstract
Reference: practicalradonc.org/article/S1879-8500(17)30043-7/abstract
Breast Cancer Congress in Vienna March 2019: Long-term study confirms success of intraoperative radio therapy
June 2017: New publication on IOERT by Prof. Dr. Sedlmayer
ABSTRACT: The term IORT (intraoperative radiotherapy) is currently used for various techniques that show huge differences in dose delivery and coverage of the tissue at risk. The largest evidence for boost IORT preceding whole breast irradiation (WBI) originates from intraoperative electron treatments (IOERT) with single doses around 10 Gy. At median follow-up periods at 6 years, outstandingly low local recurrence rates of less than 1% are observed. Higher local relapse rates were described for G3 tumors and triple negative breast cancers as well as for IORT following primary systemic treatment for locally advanced tumors. Even there, long term (>5y) local tumor control rates mostly beyond 95% were maintained. Compared to other boost methods, an intraoperative treatment has evident advantages in terms of precision (by avoiding a “spatial and/or temporal miss”), cosmetic outcome and patient comfort. Directvisualisation of a tumor bed during surgery guarantees for an accurate dose delivery, which has additionally gained importance in times of primary reconstruction techniques after lumpectomy, since IORT is performed before breast tissue including parts of the tumor bed is mobilized for plastic purposes. As a consequence of direct tissue exposure without distension by hematoma/seroma, IORT allows for small treatment volumes and complete skin sparing, both having a positive effect on late tissue tolerance and, hence, cosmetic appearance. Boost IORT marginally prolongs the surgical procedure, while significantly shortening postoperative radiotherapy. Its combination with external beam radiotherapy to the whole breast (WBI) is currently tested in two multicentric prospective trials: as kV-IORT in the multicentric TARGIT-B (oost) study, and as IOERT in the HIOB trial (3 weeks hypofractionated WBI preceded by IORT electron boost).
PDF-Download: www.ncbi.nlm.nih.gov/pmc/articles/PMC5244574/pdf/13014_2016_Article_749.pdf
Referenz: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244574/
PDF-Download: www.ncbi.nlm.nih.gov/pmc/articles/PMC5244574/pdf/13014_2016_Article_749.pdf
Referenz: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244574/
Professor Umberto Veronesi and the European Institute of Oncology
“ELIOT: electron IORT Single Dose has now solid evidence."
Professor Umberto Veronesi of the European Institute of Oncology defined how reliable and effective it is to treat selected patients with electron beam directly in operating room. With two LIAC and one NOVAC mobile accelerators, 651 patients were treated from 2000 to 2007. Results reinforce the effectiveness of electron IORT, an alternative to conventional postoperative radiotherapy. In order to justify the validity of the procedure, the trial was considered satisfactory with pre-specified equivalence margin with local recurrence of 7.5% in the five years following the excision of the tumor. At the end of the study, percentage of local relapses is 2.5 % and 1.9% is the number of new ipsilateral breast tumours. Furthermore it is observed that the overall survival is of 96.8 % , exactly comparable to conventional radiotherapy. Analyzing subgroups sorted by age, histology , tumor size and others, it is possible to define where and how the effectiveness of the procedure IORT with electron finds its maximum benefit. Finally , the cosmetic effects of such treatment are significantly better than every other procedure, IORT and not IORT.
Future of the single dose electron IORT is now well defined: For a well selected typology of patients IEO confirms that single dose electron IORT is an efficient, safe and scientifically approved procedure. Efficiency, speed, aesthetics, cost savings for patients and hospitals: The benefits are huge and affect all aspects that a patient with breast cancer must face.
Please visit the References and PDF Download on the SIT site for more details...
Professor Umberto Veronesi of the European Institute of Oncology defined how reliable and effective it is to treat selected patients with electron beam directly in operating room. With two LIAC and one NOVAC mobile accelerators, 651 patients were treated from 2000 to 2007. Results reinforce the effectiveness of electron IORT, an alternative to conventional postoperative radiotherapy. In order to justify the validity of the procedure, the trial was considered satisfactory with pre-specified equivalence margin with local recurrence of 7.5% in the five years following the excision of the tumor. At the end of the study, percentage of local relapses is 2.5 % and 1.9% is the number of new ipsilateral breast tumours. Furthermore it is observed that the overall survival is of 96.8 % , exactly comparable to conventional radiotherapy. Analyzing subgroups sorted by age, histology , tumor size and others, it is possible to define where and how the effectiveness of the procedure IORT with electron finds its maximum benefit. Finally , the cosmetic effects of such treatment are significantly better than every other procedure, IORT and not IORT.
Future of the single dose electron IORT is now well defined: For a well selected typology of patients IEO confirms that single dose electron IORT is an efficient, safe and scientifically approved procedure. Efficiency, speed, aesthetics, cost savings for patients and hospitals: The benefits are huge and affect all aspects that a patient with breast cancer must face.
Please visit the References and PDF Download on the SIT site for more details...
Full-Dose Intraoperative Radiotherapy With Electrons During Breast-Conserving Surgery
|
Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial (Umberto Veronesi, 2013)Abstract:
Intraoperative radiotherapy with electrons (ELIOT) after conservative surgery for breast carcinoma was introduced at the IEO in 1999 as a research programme. The results on 1,822 patients treated from January 2000 to December 2008 are reported. Women with unicentric primary breast carcinoma of less than 2.5 cm in the largest diameter were assessed by imaging. All patients were treated with breast-conserving surgery (quadrantectomy). ELIOT was delivered by two mobile linear accelerators immediately after breast resection with a single dose of 21 Gy. Local side effects of ELIOT were mainly liponecrosis (4.2%) and fibrosis (1.8%). After a mean follow-up of 36.1 months, 42 women (2.3%) developed a local recurrence, 24 (1.3%) a new primary ipsilateral carcinomas and 26 (1.4%) distant metastases as first event. Forty-six women died (2.5%), 28 for breast carcinoma and 18 for other causes. Five- and ten-year survivals were, respectively, 97.4 and 89.7%. ELIOT appears a promising feature in early breast cancer treated with breast conserving surgery, reducing the exposure of normal tissues to radiations and shortening the radiation course from 6 weeks to one single session. Conclusions: ELIOT is a safe method for treating conservatively operated breasts, avoids the long period of postoperative radiotherapy, and reduces drastically the cost of radiotherapy. ELIOT reduces radiation to normal tissues and organs. Results on short-term and middle-term toxicity up to 5 years of follow-up are good. Data on local control are encouraging. Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357710/ http://www.ncbi.nlm.nih.gov/pubmed/20711810 |
Clinical Results, Sedlmeyer, 2014In all risk subgroups, a 10 Gy IOERT boost prior to WBI provided outstanding local control rates, comparing favourably to all trials with similar length of follow up.
|
Controlled Trial,
|
2013__veronesi_eliot.pdf | |
File Size: | 208 kb |
File Type: |
THE TARGIT-A DEBATE
Letters Regarding the TARGIT-A Trial: The Editor’s Introduction, Anthony Zietman, MD, FASTRO, Editor-in-Chief
|
2014 Wazer A Flawed Study (TARGIT)A Flawed Study Should Not Define A New Standard Of Care, J. Hepel and David E. Wazer
|
Intraoperative Electron Radiotherapy (IOERT) as an Alternative to Standard Whole Breast IrradiationHigher-risk women with favorable biology might also be suitable candidates for IOERT, providing the tumor biology can be determined prior to surgery.
http://www.ncbi.nlm.nih.gov/pubmed/24944552 |
ISIORT pooled analysis 2013 update: clinical and technical characteristics of intraoperative radiotherapyThis report gives an overview of patient selection and treatment modalities for the main tumor types effectively treated in a large group of active and experienced international centers using IORT. This data can be a basis for further surveys and for prospective studies devoted to analyze in depth IORT containing multimodal cancer treatment approaches.
http://www.thetcr.org/article/view/2093 |
Clinical Investigation: Breast Cancer, Leonardi 2012How do the ASTRO consensus statement guidelines for Application of accelerated partial breast irradiation fit Intraoperative Radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology.
|
2014 Fastner IORT Analysis Part 1- ELIOTIntraoperative Radiation Therapy: A Critical Analysis of the ELIOT and TARGIT Trials. Part 1—ELIO
|
2014 Fastner IORT Analysis part 2- TARGITIntraoperative Radiation Therapy: A Critical Analysis of the ELIOT and TARGIT Trials. Part 2—TARGIT
|
2013 Outrial with GEC-ESTRO RecAccelerated partial breast irradiation with intraoperative electrons: Using GEC-ESTRO recommendations as guidance for patient selection
|