Riassunto
La radioterapia intraoperatoria (intraoperative radiotherapy; IORT) è la somministrazione di una singola elevata dose di radiazioni al letto tumorale durante resezione chirurgica. Questa modalità radioterapica viene applicata in associazione alla chirurgia e alla radioterapia a fasci esterni (external beam radiotherapy; EBRT) o alla chemioterapia nel trattamento dei tumori localmente avanzati dell’addome, della pelvi, del collo, del cranio, del torace e delle estremità [1], con l’obiettivo finale di migliorare il controllo locoregionale del tumore [2]. La prima IORT con fasci di elettroni (IOERT) è stata effettuata nel novembre 1976 presso la Howard University, in un bunker dotato di sala operatoria. Nel 1980, al fine di combinare i vantaggi tecnici della brachiterapia con i vantaggi logistici della IORT, al Memorial Sloan-Kettering Cancer Center è stata implementata la brachiterapia IORT ad alte dosi (HDR-IORT), utilizzando una macchina HDR portatile (OMIT) [2,3]. A partire dagli anni ’90, per risolvere i problemi logistici della IORT, sono stati creati acceleratori lineari dedicati. Attualmente, 220 unità mobili sono installate in tutto il mondo: il 40% negli Stati Uniti, il 35% in Europa e il 25% in Giappone. Esistono tre principali modelli utilizzati nella pratica clinica [4]: Mobetron, della “Intraop Medical Incorporated”, California USA, Novac7 (Fig. 5.1), della “New Radiant Technology”, Italia e la Liac di “Sordina”, Italia. Queste macchine sono piccoli acceleratori lineari per la produzione di fasci di elettroni, posizionabili direttamente nelle sale operatorie esistenti senza particolare schermatura [5]. Infine, il raggio laser Photon Radiosurgery System (Zeiss Inc, Germania) viene impiegato per il trattamento del carcinoma mammario [6]: è una sorgente in miniatura di raggi X a fasci di elettroni che fornisce una sorgente puntiforme a bassa energia di raggi X (massimo 50 kV) sulla punta di un tubo di diametro di 3,2 millimetri.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
Bibliografia
Palta JR, Biggs PJ, Hazle JD et al (1995) Intraoperative electron beam radiation therapy: technique, dosimetry, and dose specification: report of task force 48 of the radiation therapy committee, american association of physicists in medicine. Int J Rad Oncol Biol Phys 33:725–746
Gunderson LL, Willet CG, Harrison LB, Calvo FA (1999) Intraoperative irradiation. Techniques and results. Humana Press, Totowa, New Jersey
Calvo FA, Meirino RM, Orecchia R (2006) Intraoperative radiation therapy. First part: rationale and techniques. Crit Rev Oncol Hematol 59:106–115
Beddar AS, Biggs PJ, Chang S et al (2006) Intraoperative radiation therapy using mobile electron linear accelerators: Report of AAPM Radiation Therapy Committee Task Group No. 72. Med Phys 33:1476–1489
Daves JL, Mills MD (2001) Shielding assessment of a mobile electron accelerator for intraoperative radiotherapy. J Appl Clin Med Phys 2:165–173
Calvo FA, Meirino RM, Orecchia R (2006) Intraoperative radiation therapy. Part 2: Clinical results. Crit Rev Oncol Hematol 59:116–127
Istituto Superiore della Sanità (2003) Linee guida per la garanzia di qualità nella radioterapia intraoperatoria. Rapporti ISTISAN 03/1 IT
Valentini V, Moranti AG, Macchia G et al (2008) Intraoperative radiation therapy in resected pancreatic carcinoma: long-term analysis. Int J Rad Oncol Biol Phys 70:1094–1099
Hiraoka T, Kanemitsu K (1999) Value of extended resection and intraoperative radiotherapy for resectable pancreatic cancer. World J Surg 23:930–936
Ruano-Ravina A, Almazán Ortega R, Guedea F (2008) Intraoperative radiotherapy in pancreatic cancer: a systematic review. Radiother Oncol 87:318–325
Calvo FA, Valentini V (2008) Radiotherapy for pancreatic cancer: Systematic nihilism or intraoperative realism. Radiother Oncol 87:314–317
Wiig JN, Poulsen JP, Tveit KM et al (2000) Intra-operative irradiation (IORT) for primary advanced and recurrent rectal cancer: a need for randomised studies. Eur J Cancer 36:868–874
Dresen RC, Gosen MJ, Martijn H et al (2008) Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol 15:1937–1947
Pezner RD, Chu DZJ, Ellenhorn JDI (2002) Intraoperative radiation therapy for patients with recurrent rectal cancer and sigmoid colon cancer in previously irradiated fields. Radiother Oncol 64:47–52
Mathis KL, Nelson H, Pemberton JH et al (2008) Unresectable colorectal cancer can be cured with multimodality therapy. Ann Surg 284:592–598
Bobin JY, Al-Lawati T, Granero LE et al (2003) Surgical management of retroperitoneal sarcomas associated with external and intraoperative electron beam radiotherapy. Eur J Surg Oncol 29:676–681
Caudle AS, Tepper JE, Calvo BF et al (2006) Complications associated with neoadjuvant radiotherapy in the multidisciplinary treatment of retroperitoneal sarcomas. Ann Surg Oncol 14:577–582
Ballo MT, Zagars GK, Pollock RE et al (2007) Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment. Int J Rad Oncol Biol Phys 67:158–163
Sindelar WF, Kinsella TJ, Chen PW et al (1993) Intraoperative radiotherapy in retroperitoneal sarcomas: final results of a prospective, randomized, clinical trial. Arch Surg 128:402–410
Veronesi U, Orecchia R, Luini A et al (2005) Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg 242:101–106
Sacchini V, Beal K, Goldberg J et al (2008) Study of quadrant high-dose intraoperative radiation therapy for early-stage breast cancer. Br J Surg 95:1105–1110
Holmes DR, Baum M, Joseph D (2007) The TARGIT trial: targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update). Am J Surg 194:507–510
Kraus-Tiefenbacher U, Bauer L, Scheda A et al (2007) Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer 14:178
Sedlmayer F, Faster G, Merz F et al on behalf of the ISIORT Europe (2007) IORT with electrons as a boost strategy during breast conserving therapy in limited stage breast cancer: results of an ISIORT pooled analysis. Strahlenther Onkol 183:32–34
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Italia
About this chapter
Cite this chapter
Ricardi, U., Rampino, M., Rondi, N., Mussa, B., Marsanic, P. (2011). Radioterapia intraoperatoria. In: Nuove tecnologie chirurgiche in oncologia. Springer, Milano. https://doi.org/10.1007/978-88-470-2385-7_5
Download citation
DOI: https://doi.org/10.1007/978-88-470-2385-7_5
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2384-0
Online ISBN: 978-88-470-2385-7
eBook Packages: MedicineMedicine (R0)