Intraoperative radiation therapy opportunities for clinical practice normalization: Data recording and innovative development

Abstract

Background

Intraoperative radiotherapy (IORT) refers to the delivery of a high dose of radiation at the time of surgery.

Aim

To analyze clinical and research-oriented innovative activities developed in a 17-year period using intraoperative electron-radiation therapy (IOeRT) as a component of treatment in a multidisciplinary approach for cancer management.

Materials and methods

From 01/1995 to 03/2012 IOeRT procedures were registered in a specific Hospital-based database. Research and developments in imaging and recording for treatment planning implementation are active since 2006.

Results

1004 patients were treated and 1036 IORT procedures completed. Median age of patients was 61 (range 5 months to 94 years). Gender distribution was male in 54% of cases and female in 46%. Disease status at the time of IORT was 796 (77%) primary and 240 (23%) recurrent. Cancer type distribution included: 62% gastrointestinal, 18% sarcoma, 5% pancreas, 2% paediatric, 3% breast, 77 7% oligotopic recurrences, 2% other. IORT technical characteristics were: Applicator size 5[[ce:hsp sp="0.25"/]]cm 22%, 6[[ce:hsp sp="0.25"/]]cm 21%, 7[[ce:hsp sp="0.25"/]]cm 21%, 8[[ce:hsp sp="0.25"/]]cm 15%, 9[[ce:hsp sp="0.25"/]]cm 6%, 10[[ce:hsp sp="0.25"/]]cm 7% 12[[ce:hsp sp="0.25"/]]cm 5% 15[[ce:hsp sp="0.25"/]]cm 3%. Electron energies: 6[[ce:hsp sp="0.25"/]]MeV 19%, 8[[ce:hsp sp="0.25"/]]MeV 15%, 10[[ce:hsp sp="0.25"/]]MeV 15%, 12[[ce:hsp sp="0.25"/]]MeV 23%, 15[[ce:hsp sp="0.25"/]]MeV 19%, 18[[ce:hsp sp="0.25"/]]MeV 6%, other 3%. Multiple fields: 108 (11%). Dose: 7.5[[ce:hsp sp="0.25"/]]Gy 3%, 10[[ce:hsp sp="0.25"/]]Gy 35%, 12[[ce:hsp sp="0.25"/]]Gy 3%, 12.5[[ce:hsp sp="0.25"/]]Gy 49%, 15[[ce:hsp sp="0.25"/]]Gy 5%, other 5%.

Conclusion

An IORT programme developed in an Academic Hospital based on practice-oriented medical decisions is an attractive interdisciplinary oncology initiative proven to be able to generate an intensive clinical activity for cancer patient quality care and a competitive source of scientific patient-oriented research, development and innovation.