High- and low-dose-rate intraoperative radiotherapy for thoracic malignancies resected with close or positive margins

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• 作者：Christopher Fleming¹ ; Andreas Rimner¹ ; Gil'ad N. Cohen² ; Kaitlin M. Woo³ ; Zhigang Zhang³ ; Kenneth E. Rosenzweig⁴ ; Kaled M. Alektiar¹ ; Michael J. Zelefsky¹ ; Manjit S. Bains⁵ ; Abraham J. Wu¹ ; ^{wua@mskcc.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Intraoperative radiotherapy ; High-dose rate ; Thorax
• 刊名：Brachytherapy
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：15
• 期：2
• 页码：208-215
• 全文大小：1066 K

文摘

Local recurrence is a significant problem after surgical resection of thoracic tumors. As intraoperative radiotherapy (IORT) can deliver radiation directly to the threatened margin, we have used this therapy in an attempt to reduce local recurrence, using high-dose-rate (HDR) as well as low-dose-rate (LDR) techniques.

Methods and Materials

We performed a retrospective review of patients undergoing LDR (¹²⁵I) mesh placement or HDR (¹⁹²Ir) afterloading therapy during lung tumor resection between 2001 and 2013 at our institution. Competing risks methods were used to estimate the cumulative incidence of local failure. We also assessed possible predictive factors of local failure.

Results

Fifty-nine procedures (41 LDR and 18 HDR) were performed on 58 patients. Median follow-up was 55.1 months. Cumulative incidence of local failure at 1, 2, and 3 years was 28.5%, 34.2%, and 34.2%, respectively. Median overall survival was 39.9 months. There was no significant difference in local failure according to margin status, HDR vs. LDR, use of adjuvant external beam radiotherapy, or metastatic vs. primary tumor. Two patients (3.4%) experienced Grade 3+ toxicities likely related to brachytherapy. Additionally, 7 patients experienced Grade 3+ postsurgical complications unlikely related to brachytherapy.

Conclusions

IORT is associated with good local control after resection of thoracic tumors otherwise at very high risk for local recurrence. There is a low incidence of severe toxicity attributable to brachytherapy. HDR-IORT appears to have equivalent outcomes to LDR-IORT. HDR or LDR-IORT can, therefore, be considered in situations where the oncologic completeness of thoracic tumor resection is in doubt.