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Brachytherapy. 2016 Mar-Apr;15(2):208-15. doi: 10.1016/j.brachy.2015.11.007. Epub 2016 Jan 26.

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

Author information

1
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
2
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY.
3
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
4
Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY.
5
Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
6
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: wua@mskcc.org.

Abstract

PURPOSE:

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 ((125)I) mesh placement or HDR ((192)Ir) 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.

KEYWORDS:

High-dose rate; Intraoperative radiotherapy; Thorax

PMID:
26825857
PMCID:
PMC4789132
[Available on 2017-03-01]
DOI:
10.1016/j.brachy.2015.11.007
[Indexed for MEDLINE]
Free PMC Article

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