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11 results on '"Felipe A. Calvo"'

1. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in primary locally advanced rectal cancer

Author

Felipe A. Calvo, Claudio V. Sole, Harm J. Rutten, Philip Poortmans, Jose M. Asencio, Javier Serrano, Javier Aristu, Falk Roeder, and Wim J Dries

Subjects
Rectal cancer, Locally advanced disease, Intraoperative radiotherapy, Radical surgery, Electron beam, Neoadjuvant treatment, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Summary: Carcinoma of the rectum is a heterogeneous disease. The clinical spectrum identifies a subset of patients with locally advanced tumours that are close to or involve adjoining structures, such as the sacrum, pelvic sidewalls, prostate or bladder. Within this group of patients categorized as “locally advanced”, there is also variability in the extent of disease with no uniform definition of resectability. A practice-oriented definition of a locally advanced tumour is a tumour that cannot be resected without leaving microscopic or gross residual disease at the resection site. Since these patients do poorly with surgery alone, irradiation and chemotherapy have been added to improve the outcome. Intraoperative irradiation (IORT) is a component of local treatment intensification with favourable results in this subgroup of patients.International guidelines (National Comprehensive Cancer Network (NCCN) guidelines) currently recommend the use of IORT for rectal cancer resectable with very close or positive margins, especially for T4 and recurrent cancers.We report the ESTRO-ACROP (European Society for Radiotherapy and Oncology - Advisory Committee on Radiation Oncology Practice) recommendations for performing IORT in primary locally advanced rectal cancer.

Published
2020
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2. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in locally recurrent rectal cancer

Author

Felipe A. Calvo, Claudio V. Sole, Harm J. Rutten, Wim J. Dries, Miguel A. Lozano, Mauricio Cambeiro, Philip Poortmans, and Luis González-Bayón

Subjects
Rectal cancer, Recurrent disease, Oligo-recurrence, Intraoperative radiotherapy, Rescue surgery, Electron beam, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Multimodal strategies have been implemented for locally recurrent rectal cancer scheduled for complete surgical resection. Irradiation and systemic therapy have been added to improve the oncological outcome, as surgery alone was associated with a poor prognosis. Intraoperative irradiation (IORT) is a component of irradiation intensification. Long-term cancer control and a higher survival rate were consistently reported in patients who had IORT as a component of their multidisciplinary treatment. The experience reported by expert IORT groups is reviewed and recommendations to guide clinical practice are explained in detail.

Published
2020
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3. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer

Author

Felipe A. Calvo, Jose M. Asencio, Falk Roeder, Robert Krempien, Philip Poortmans, Frank W. Hensley, and Marco Krengli

Subjects
Pancreatic cancer, Borderline, Intraoperative radiotherapy, IORT, IOERT, Electron beam, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise RT modality to intensify the irradiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoradiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemotherapy followed by chemoradiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer.

Published
2020
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4. Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis

Author

Gian Carlo Mattiucci, Alessio G. Morganti, Francesco Cellini, Milly Buwenge, Riccardo Casadei, Andrea Farioli, Sergio Alfieri, Alessandra Arcelli, Federica Bertini, Felipe A. Calvo, Silvia Cammelli, Lorenzo Fuccio, Lucia Giaccherini, Alessandra Guido, Joseph M. Herman, Gabriella Macchia, Bert W. Maidment, III, Robert C. Miller, Francesco Minni, William F. Regine, Michele Reni, Stefano Partelli, Massimo Falconi, and Vincenzo Valentini

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter 353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and 30 mm (P50.0 Gy showed improved OS (P

Published
2019
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5. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in locally recurrent rectal cancer

Author

M.A. Lozano, Claudio V. Sole, Philip Poortmans, Felipe A. Calvo, L. Gonzalez-Bayon, Harm J. T. Rutten, Wim Dries, Mauricio Cambeiro, Surgery, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy

Subjects
Surgical resection, Electron beam, medicine.medical_specialty, Intraoperative radiotherapy, Colorectal cancer, SURGERY, medicine.medical_treatment, Brachytherapy, R895-920, Systemic therapy, Article, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, CHEMORADIATION, Medical physics. Medical radiology. Nuclear medicine, 0302 clinical medicine, medicine, Recurrent disease, Radiology, Nuclear Medicine and imaging, MULTIMODALITY TREATMENT, Rectal cancer, Rescue surgery, Intraoperative radiation therapy, Survival rate, RC254-282, Recurrent Rectal Cancer, RADIOTHERAPY IORT, business.industry, BRACHYTHERAPY, Intraoperative irradiation, Oligo-recurrence, SURGICAL RESECTION, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, ELECTRON-BEAM, IRRADIATION, Oncology, 030220 oncology & carcinogenesis, PELVIC RECURRENCE, Radiology, business, REIRRADIATION
Abstract

Highlights • Radiation dose escalation with intraoperative electron beam is feasible in the pelvic region. • IORT is an option to minimize radiation toxicity to ureters, bladder, prostate, vagina, uterus, small bowel. • Preoperative therapy, including a re-irradiation component, allows selection of patient candidates for local treatment intensification. • R0 status IOERT results supports individualized recommendation in expert clinical practice. • Survival contribution is described in oligo-recurrent patients amenable for radical rescue surgery without previous pelvic radiotherapy., Multimodal strategies have been implemented for locally recurrent rectal cancer scheduled for complete surgical resection. Irradiation and systemic therapy have been added to improve the oncological outcome, as surgery alone was associated with a poor prognosis. Intraoperative irradiation (IORT) is a component of irradiation intensification. Long-term cancer control and a higher survival rate were consistently reported in patients who had IORT as a component of their multidisciplinary treatment. The experience reported by expert IORT groups is reviewed and recommendations to guide clinical practice are explained in detail.

Published
2020

6. Assessment of intraoperative 3D imaging alternatives for IOERT dose estimation

Author

Eduardo Alvarado-Vásquez, Kirby G. Vosburgh, Claudio V. Sole, Javier Pascau, Manlio F. Valdivieso-Casique, Manuel Desco, Felipe A. Calvo, Verónica García-Vázquez, Eugenio Marinetto, Pedro Guerra, Comunidad de Madrid, and Ministerio de Economía y Competitividad (España)

Subjects
medicine.medical_specialty, Intraoperative Imaging, Medicina, medicine.medical_treatment, Biophysics, Electrons, Dose distribution, computer.software_genre, Strahlentherapie, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Intraoperative Period, 0302 clinical medicine, Imaging, Three-Dimensional, Unresected, Voxel, Neoplasms, Dose estimation, Multidetector Computed Tomography, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Dosisverteilung, Biología y Biomedicina, Telecomunicaciones, Radiological and Ultrasound Technology, Radiotherapy, business.industry, Truebeam, Radiotherapy Dosage, Gold standard (test), Cone-Beam Computed Tomography, 3. Good health, IOERT, Radiation therapy, Radiology Nuclear Medicine and imaging, 030220 oncology & carcinogenesis, Intraoperative bildgebung, Electrónica, Intraoperative electron radiation therapy, Radiology, business, Nuclear medicine, Tomography, X-Ray Computed, computer
Abstract

Intraoperative electron radiation therapy (IOERT) involves irradiation of an unresected tumour or a post-resection tumour bed. The dose distribution is calculated from a preoperative computed tomography (CT) study acquired using a CT simulator. However, differences between the actual IOERT field and that calculated from the preoperative study arise as a result of patient position, surgical access, tumour resection and the IOERT set-up. Intraoperative CT imaging may then enable a more accurate estimation of dose distribution. In this study, we evaluated three kilovoltage (kV) CT scanners with the ability to acquire intraoperative images. Our findings indicate that current IOERT plans may be improved using data based on actual anatomical conditions during radiation. The systems studied were two portable systems (“O-arm”, a cone-beam CT [CBCT] system, and “BodyTom”, a multislice CT [MSCT] system) and one CBCT integrated in a conventional linear accelerator (LINAC) (“TrueBeam”). TrueBeam and BodyTom showed good results, as the gamma pass rates of their dose distributions compared to the gold standard (dose distributions calculated from images acquired with a CT simulator) were above 97% in most cases. The O-arm yielded a lower percentage of voxels fulfilling gamma criteria owing to its reduced field of view (which left it prone to truncation artefacts). Our results show that the images acquired using a portable CT or even a LINAC with on-board kV CBCT could be used to estimate the dose of IOERT and improve the possibility to evaluate and register the treatment administered to the patient. Dosisverteilung wird aus einer präoperativen Computertomographie (CT)-Studie berechnet, für die ein CT-Simulator verwendet wurde. Resultierend aus der Patientenposition, dem chirurgischen Zugang, der Tumorresektion und dem IOERT-Aufbau tritt jedoch eine Abweichung zwischen dem tatsächlichen IOERT-Feld und dem aus der präoperativen Aufnahme berechneten Feld auf. Die Intraoperative CT-Bildgebung kann unter diesen Umständen eine genauere Einschätzung der Dosisverteilung ermöglichen. In dieser Studie haben wir drei Kilovolt (kV)-Computertomographgeräte bewertet, die intraoperative Bilder erstellen können. Unsere Ergebnisse weisen darauf hin, dass aktuelle IOERT-Behandlungspläne mittels Daten verbessert werden können, die auf tatsächlichen anatomischen Gegebenheiten während der Bestrahlung basieren. Es wurden zwei tragbare Systeme („O-Arm“, ein cone-beam-CT [CBCT]-System und „BodyTom“, ein Mehrschicht-CT [MSCT]-System) und ein in einen konventionellen Linearbeschleuniger integriertes CBCT-System (LINAC) namens „TrueBeam“ untersucht. TrueBeam und BodyTom zeigten gute Ergebnisse, da die Gamma-Akzeptanzrate der Dosisverteilungen im Vergleich zum Goldstandard (Berechnung der Dosisverteilungen anhand von mit einem CT-Simulator aufgenommenen Bildern) in den meisten Fällen über 97% lag. Der O-Arm ergab einen niedrigeren Prozentsatz an Voxel, die die Gamma-Kriterien erfüllen. Dies liegt an seinem verminderten Sichtfeld, das seine Anfälligkeit für Truncation-Artefakte erhöht. Unsere Ergebnisse belegen die Verwendbarkeit von Bildern zur Einschätzung der IOERT-Dosis, die mit Hilfe eines tragbaren CT oder sogar eines LINAC mit On-Board-kV-CBCT erstellt wurden. Hierdurch können die Behandlungsdosen der Patienten besser bewertet und erfasst werden. This study was supported by projects IPT-2012-0401-300000, TEC2013-48251-C2-1-R, DTS14/00192, PI-15/02121 (Ministerio de Economía y Competitividad, ISCIII), TOPUS-CM S2013/MIT-3024 (Comunidad de Madrid) and FEDER funds. We would like to acknowledge the support of the Madrid-MIT M+Vision Consortium in facilitating this study. KG Vosburgh received support from the National Center for Image Guided Therapy under NIH P41 EB015898. The authors also extend their gratitude to Medtronic, NeuroLogica Corporation, Department of Radiation Oncology at Clínica La Luz, Hospital Universitario La Paz, radiotherapy technicians at Hospital General Universitario Gregorio Marañón and Iván Balsa for their support with data acquisition. We are also grateful to the Department of Radiation Oncology at Hospital Universitario Ramón y Cajal for providing the electron density phantom, CIRS company for supplying the chemical composition of the phantom, Cristina González and Ramón Polo for providing image quality performance of the CT simulator, and Claudia de Molina and Alejandro Sisniega for technical assistance with CT artefacts. We would also like to express our sincere gratitude to the late Professor Juan Antonio Santos-Miranda for his practical and insightful suggestions regarding the task of improving IOERT procedures. Publicado

Published
2017

7. Intraoperative Irradiation

Author

Brian G. Czito, Manisha Palta, Felipe A. Calvo, Christopher G. Willett, and Michael G. Haddock

Subjects
business.industry, Intraoperative irradiation, Medicine, business, Nuclear medicine
Published
2016

8. Contributors

Author

Ross A. Abrams, David J. Adelstein, Kaled M. Alektiar, Brian Alexander, Jan Alsner, Ersan Altun, Bethany Anderson, K. Kian Ang, Douglas W. Arthur, Jonathan B. Ashman, Matthew T. Ballo, Christopher Andrew Barker, Beth M. Beadle, Phillipe Bedard, Jonathan J. Beitler, Michael W. Bishop, A. William Blackstock, Jeffrey A. Bogart, James A. Bonner, J. Daniel Bourland, Joseph Bovi, John Breneman, Juan P. Brito, Paul D. Brown, Michael D. Brundage, Thomas A. Buchholz, Bryan Henry Burmeister, Stuart K. Calderwood, Matthew D. Callister, Felipe A. Calvo, George M. Cannon, Bruce A. Chabner, Michael D. Chan, Sam T. Chao, Anne-Marie Charpentier, Christine H. Chung, Peter W.M. Chung, Louis S. Constine, Benjamin W. Corn, Allan Covens, Oana I. Craciunescu, Christopher H. Crane, Carien L. Creutzberg, Juanita M. Crook, Walter J. Curran, Brian G. Czito, Bouthaina S. Dabaja, Shiva Das, Marc David, Laura A. Dawson, Thomas F. DeLaney, Phillip M. Devlin, Mark Dewhirst, Don S. Dizon, Jeffrey S. Dome, John H. Donohue, Thierry P. Duprez, Jason A. Efstathiou, Avraham Eisbruch, David W. Eisele, Mary Feng, Rui P. Fernandes, Julia R. Fielding, Gini F. Fleming, Robert L. Foote, Benedick A. Fraass, Carolyn R. Freeman, Adam S. Garden, Lindell R. Gentry, Lilian T. Gien, Mary K. Gospodarowicz, Cai Grau, Vincent Grégoire, Craig M. Greven, Kathryn McConnell Greven, Leonard L. Gunderson, Michael G. Haddock, Michele Halyard, Marc Hamoir, Timothy Paul Hanna, Paul M. Harari, Ian D. Hay, Joseph M. Herman, Caroline L. Holloway, Theodore Sunki Hong, Neil S. Horowitz, Michael R. Horseman, Julie Howle, Brian A. Hrycushko, David Hsu, Patricia A. Hudgins, Ryan C. Hutchinson, Christine Iacobuzio-Donahue, Benjamin Izar, Valerie L. Jewells, Joseph Gerard Jurcic, John A. Kalapurakal, Brian D. Kavanagh, Kara M. Kelly, Amir H. Khandani, Deepak Khuntia, Ana Ponce Kiess, Susan J. Knox, Wui-Jin Koh, Matthew J. Krasin, Larry E. Kun, Nadia Issa Laack, Ann S. LaCasce, Corey Jay Langer, George E. Laramore, Andrew B. Lassman, Colleen A.F. Lawton, Nancy Lee, Benoît Lengelé, William P. Levin, Jacob C. Lindegaard, John T. Lucas, Shannon M. MacDonald, William J. Mackillop, Anuj Mahindra, Anthony A. Mancuso, Karen Jean Marcus, Lawrence B. Marks, Diana Matceyevsky, Jean-Jacques Mazeron, Mark W. McDonald, Paul M. Medin, Minesh P. Mehta, William M. Mendenhall, Ruby F. Meredith, Jeff M. Michalski, Michael T. Milano, Bruce D. Minsky, William H. Morrison, Erin S. Murphy, Rashmi K. Murthy, Andrea K. Ng, Marianne Nordsmark, Desmond A. O'Farrell, Paul Okunieff, Roger Ove, Jens Overgaard, Manisha Palta, Alexander S. Parker, Luke E. Pater, Jennifer L. Peterson, Thomas M. Pisansky, Louis Potters, Harry Quon, David Raben, Abram Recht, Ramesh Rengan, Marsha, Laufer Reyngold, Nadeem Riaz, Stephen S. Roberts, Kenneth B. Roberts, Jason K. Rockhill, Claus M. Rödel, Carlos Rodriguez-Galindo, C. Leland Rogers, Todd L. Rosenblat, William G. Rule, Anthony Henryk Russell, Suzanne Russo, David P. Ryan, John Torsten Sandlund, Pamela L. Sandow, Daniel J. Sargent, Steven E. Schild, Michael Heinrich Seegenschmiedt, Chirag Shah, Edward G. Shaw, Jason P. Sheehan, Arif Sheikh, Qian Shi, Malika L. Siker, William Small, Benjamin D. Smith, Grace L. Smith, Timothy D. Solberg, Paul R. Stauffer, Mary Ann Stevenson, Alexandra J. Stewart, John H. Suh, Winston W. Tan, Joel E. Tepper, Charles R. Thomas, Gillian M. Thomas, Robert D. Timmerman, Richard W. Tsang, Kenneth Y. Usuki, Vincenzo Valentini, Vicente Valero, Martin J. van den Bent, Michael J. Veness, Frank A. Vicini, Danielle Vicus, Akila N. Viswanathan, Zeljko Vujaskovic, J. Trad Wadsworth, Henry Wagner, Daniel R. Wahl, Padraig R. Warde, Timothy V. Waxweiler, Michael J. Wehle, Robert J. Weil, Lawrence M. Weiss, John W. Werning, Christopher G. Willett, Christopher Douglas Willey, Lynn D. Wilson, Karen M. Winkfield, Jennifer Yon-Li, Suzanne L. Wolden, Terence Z. Wong, Jeffrey Y.C. Wong, William W. Wong, Wenting Wu, Joachim Yahalom, Eddy Shih-Hsin Yang, Y. Nancy You, Elaine M. Zeman, Jing Zeng, and Anthony L. Zietman

Published
2016

9. Gastric/GE Junction Cancer

Author

Joel E. Tepper, Leonard L. Gunderson, Felipe A. Calvo, and Jonathan B. Ashman

Subjects
business.industry, Cancer research, Medicine, Cancer, business, medicine.disease
Published
2012

10. Contributors

Author

Ross A. Abrams, Michelle Alonso-Basanta, Bethany M. Anderson, Kenneth C. Anderson, K. Kian Ang, Douglas W. Arthur, Gregory D. Avey, Matthew T. Ballo, Christopher A. Barker, Lawrence S. Baszkowsky, Jonathan J. Beitler, A. William Blackstock, Jeffrey A. Bogart, James A. Bonner, J. Daniel Bourland, John Breneman, Paul D. Brown, Thomas A. Buchholz, Jeffrey C. Buchsbaum, Michael Burke, Steven J. Buskirk, Stuart K. Calderwood, Matthew D. Callister, Felipe A. Calvo, George M. Cannon, Charles Catton, Bruce A. Chabner, Michael D. Chan, Sam T. Chao, Peter Chung, John J. Coen, Louis S. Constine, Benjamin W. Corn, Allan Covens, Oana Craciunescu, Carien L. Creutzberg, Juanita Crook, Walter J. Curran, Brian G. Czito, Shiva Das, Marc David, Thomas F. DeLaney, Mark Dewhirst, Colleen Dickie, Jeffrey S. Dome, John H. Donohue, Thierry Duprez, Pinaki Dutta, Jason A. Efstathiou, Avraham Eisbruch, Mary Feng, Rui P. Fernandes, Julia R. Fielding, Gini F. Fleming, Robert L. Foote, Benedick A. Fraass, Adam S. Garden, Lindell R. Gentry, Michel Ghilezan, Mary K. Gospodarowicz, Cai Grau, Vincent Grégoire, Craig M. Greven, Kathryn McConnell Greven, Leonard L. Gunderson, Michael G. Haddock, Marc Hamoir, Paul M. Harari, Ian D. Hay, Kara Hertzfeld, David Hogg, Michael R. Horsman, Patricia A. Hudgins, Melissa M. Hudson, Valerie S. Jewells, Shruti Jolly, Glenn Jones, John A. Kalapurakal, Amir H. Khandani, Deepak Khuntia, Susan J. Knox, Wui-Jin Koh, Matthew J. Krasin, Deborah A. Kuban, Larry E. Kun, Ann S. LaCasce, George E. Laramore, Andrew B. Lassman, Marsha Laufer, Ruth Lavigne, Theodore S. Lawrence, Colleen A. Lawton, Nancy Lee, Benoît Lengelé, William P. Levin, Alexander Lin, Jacob C. Lindegaard, William J. Mackillop, Anuj Mahindra, Anthony A. Mancuso, Karen J. Marcus, Lawrence B. Marks, James A. Martenson, Alvaro A. Martinez, Peter Mauch, Jean-Jacques Mazeron, Derek R. McHaffie, Minesh P. Mehta, William M. Mendenhall, Thomas E. Merchant, Ruby F. Meredith, Jeff Michalski, Michael T. Milano, Lara P. Bonner Millar, Bruce D. Minsky, David H. Moore, William H. Morrison, Jason G. Newman, Andrea K. Ng, Marianne Nordsmark, Shannon Offerman, Paul Okunieff, Bert O’Neil, Brian O'Sullivan, Roger Ove, Jens Overgaard, Alexander S. Parker, Michael Paulussen, Ivy A. Petersen, Jennifer L. Peterson, Thomas M. Pisansky, Arthur T. Porter, Louis Potters, Thomas J. Pugh, Harry Quon, David Raben, Abram Recht, Ramesh Rengan, Kenneth B. Roberts, Jason K. Rockhill, Claus Rödel, Carlos Rodriguez-Galindo, C. Leland Rogers, Anthony H. Russell, Suzanne Russo, John T. Sandlund, Pamela R. Sandow, Daniel J. Sargent, Carolyn I. Sartor, Dan Schifter, Steven E. Schild, Andreas Schuck, Michael Heinrich Seegenschmiedt, Anand P. Shah, Edward G. Shaw, Arif Sheikh, William U. Shipley, Malika L. Siker, Lillian L. Siu, William Small, Benjamin D. Smith, Paul Stauffer, Mary Ann Stevenson, Volker W. Stieber, John H. Suh, Jeffrey G. Supko, Winston W. Tan, Joel E. Tepper, Charles R. Thomas, Gillian M. Thomas, Donald Thrall, Wolfgang Tomé, Richard W. Tsang, Vincenzo Valentini, Martin J. van den Bendt, Ate G.J. Van der Zee, Michael J. Veness, Frank A. Vicini, Danielle Vicus, Zeljko Vujaskovic, J. Trad Wadsworth, Henry Wagner, Padraig R. Warde, Michael J. Wehle, Robert J. Weil, Jared Weiss, Lawrence Weiss, John W. Werning, Christopher G. Willett, Christopher D. Willey, Lynn D. Wilson, Suzanne Wolden, Jeffrey Y.C. Wong, William W. Wong, Wenting Wu, Joachim Yahalom, Y. Nancy You, Elaine M. Zeman, and Anthony L. Zietman

Published
2012

11. Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Author

Santiago Amillo, José Manuel Aramendía, Ignacio Azinovic, E. Villafranca, Oscar Fernandez Hidalgo, Felipe A. Calvo, Miguel San Julian, José Javier Aristu, Rafael Martinez Monge, Carlos Villas, and Esteban Salgado

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Soft Tissue Neoplasms, Cohort Studies, Radiotherapy, High-Energy, Intraoperative Period, Intraoperative Period/adverse effects/methods, medicine, Humans, Combined Modality Therapy, Radiology, Nuclear Medicine and imaging, Peripheral Nerves, Treatment Failure, External beam radiotherapy, Child, Survival analysis, Aged, Chemotherapy, business.industry, Soft tissue sarcoma, Soft tissue, Extremities, Radiotherapy Dosage, Sarcoma, Histology, Hematology, Middle Aged, medicine.disease, Survival Analysis, Surgery, Radiation therapy, Oncology, Female, Neoplasm Recurrence, Local/radiotherapy, Neoplasm Recurrence, Local, business, Peripheral Nerves/radiation effects
Abstract

To analyze the patterns of failure and the toxicity profile of intraoperative electron beam radiotherapy (IOERT) after resection of soft tissue sarcomas of the extremities (STS). PATIENTS AND METHODS: Forty-five patients with extremity STS were treated with IOERT and moderate-dose postoperative radiotherapy (45-50 Gy). Twenty-six patients were treated for primary disease (PD) and 19 patients for an isolated recurrence (ILR). Tumor size was >5 cm (maximum diameter) in 36 patients (80%), and high-grade histology in PD patients was present in 14 patients (54%). In nine patients, IOERT was used alone, due to previous irradiation or patient refusal. Chemotherapy (neoadjuvant and/or adjuvant) was mainly given to high-grade tumors. RESULTS: Nine patients relapsed in the extremity (20%), and 12 patients in distant sites (28%). Actuarial local control at 5 years was 88% for patients with negative/close margins and 57% for patients presenting positive margins (P=0.04). Five patients (11%) developed neuropathy associated with the treatment. Extremity preservation was achieved in 40 patients (88%). With a median follow-up of 93 months (range: 27-143 months) for the patients at risk, 25 patients remain alive (a 7-year actuarial survival rate of 75% for PD and 47% for ILR; P=0.01). CONCLUSIONS: IOERT combined with moderate doses of external beam irradiation yields high local control and extremity preservation rates in resected extremity STS. Peripheral nerves in the IOERT field are dose-limiting structures requiring a dose compromise in the IOERT component to avoid severe neurological damage.

Published
2003

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