Intraoperative radiotherapy: review of techniques and results
Intraoperative radiotherapy: review of techniques and results
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DOI：
10.3332/ecancer.2017.750
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发表时间：
2017-06-29
影响因子：
1.8
通讯作者：
Laskar, Siddhartha
中科院分区：
文献类型：
--
作者：
Pilar, Avinash;Gupta, Meetakshi;Laskar, Siddhartha
术中放射治疗（IORT）是一种在手术过程中向肿瘤或肿瘤床精确输送大剂量电离辐射的技术。肿瘤床的直接可视化和将正常组织与肿瘤床隔开的能力允许对肿瘤的剂量最大化，同时对正常组织的剂量最小化。这导致IORT的治疗率提高。虽然它是在20世纪60年代引入的，但随着自屏蔽移动的直线加速器和低kV IORT设备的引入，它又重新流行起来，通过消除放射治疗手术期间运送患者或建造屏蔽手术室的后勤问题，使其能够在社区中更广泛地使用。电子，低kV X射线和HDR近距离放射治疗都是目前临床使用的不同IORT方法。每种方法都有其独特的优点和缺点，其自身的适应症，其中一种可能比另一种更适合，并且每种方法都需要特定的专业知识。IORT已在各种各样的腹腔内肿瘤，复发性结直肠癌，复发性妇科癌症和软组织肿瘤中证明了其疗效。最近，由于能够在手术期间完成整个放疗过程，它已成为选定的早期乳腺癌的一种有吸引力的治疗选择。IORT已在这些部位被用于多种作用，用于剂量递增（腹膜后肉瘤）、EBRT剂量递减（儿科肿瘤）、作为唯一的放射方式（早期乳腺癌）和作为再放射方式（复发性直肠癌和妇科癌症）。本文旨在对与当前临床实践相关的不同部位的IORT的原理、技术和结果进行综述。
Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community.Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise.IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers).This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.