Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer

An-Sofie E. Verrijssen; Wim J.F. Dries; Jeltsje S. Cnossen; Jacqueline Theuws; Heike M.U. Peulen; Hetty A. van den Berg; Dorien C. Rijkaart; Eva L.K. Voogt; Inger-Karine Kolkman-Deurloo; Joost Nuyttens; Harm J.T. Rutten; Jacobus W.A. Burger; Cathryn Huibregtse Bimmel-Nagel

doi:10.5114/jcb.2022.118305

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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Original paper

Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer

An-Sofie E. Verrijssen

^{1, 2}

,

Wim J.F. Dries

¹

,

Jeltsje S. Cnossen

¹

,

Jacqueline Theuws

¹

,

Heike M.U. Peulen

¹

,

Hetty A. van den Berg

¹

,

Dorien C. Rijkaart

¹

,

Eva L.K. Voogt

³

,

Inger-Karine Kolkman-Deurloo

⁴

,

Joost Nuyttens

⁴

,

Harm J.T. Rutten

^{2, 3}

,

Jacobus W.A. Burger

³

,

Cathryn Huibregtse Bimmel-Nagel

¹

Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

J Contemp Brachytherapy 2022; 14, 4: 370–378

DOI: https://doi.org/10.5114/jcb.2022.118305

Online publish date: 2022/07/21

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AMA

Verrijssen A, Dries W, Cnossen J, et al. Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer. Journal of Contemporary Brachytherapy. 2022;14(4):370-378. doi:10.5114/jcb.2022.118305.

APA

Verrijssen, A., Dries, W., Cnossen, J., Theuws, J., Peulen, H.,  & Berg, H. et al. (2022). Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer. Journal of Contemporary Brachytherapy, 14(4), 370-378. https://doi.org/10.5114/jcb.2022.118305

Chicago

Verrijssen, An-Sofie E., Wim J.F. Dries, Jeltsje S. Cnossen, Jacqueline Theuws, Heike M.U. Peulen, Hetty A. van den Berg,  and Dorien C. Rijkaart et al. 2022. "Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer". Journal of Contemporary Brachytherapy 14 (4): 370-378. doi:10.5114/jcb.2022.118305.

Harvard

Verrijssen, A., Dries, W., Cnossen, J., Theuws, J., Peulen, H., Berg, H., Rijkaart, D., Voogt, E., Kolkman-Deurloo, I., Nuyttens, J., Rutten, H., Burger, J.,  and Bimmel-Nagel, C. (2022). Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer. Journal of Contemporary Brachytherapy, 14(4), pp.370-378. https://doi.org/10.5114/jcb.2022.118305

MLA

Verrijssen, An-Sofie E. et al. "Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer." Journal of Contemporary Brachytherapy, vol. 14, no. 4, 2022, pp. 370-378. doi:10.5114/jcb.2022.118305.

Vancouver

Verrijssen A, Dries W, Cnossen J, Theuws J, Peulen H, Berg H et al. Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer. Journal of Contemporary Brachytherapy. 2022;14(4):370-378. doi:10.5114/jcb.2022.118305.

Purpose
Intra-operative radiotherapy (IORT) has been used as a tool to provide a high-dose radiation boost to a limited volume of patients with fixed tumors with a likelihood of microscopically involved resection margins, in order to improve local control. Two main techniques to deliver IORT include high-dose-rate (HDR) brachytherapy, termed ‘intra-operative brachytherapy’ (IOBT), and electrons, termed ‘intra-operative electron radiotherapy’ (IOERT), both having very different dose distributions. A recent paper described an improved local recurrence-free survival favoring IOBT over IOERT for patients with locally advanced or recurrent rectal cancer and microscopically irradical resections. Although several factors may have contributed to this result, an important difference between the two techniques was the higher surface dose delivered by IOBT. This article described an adaptation of IOERT technique to achieve a comparable surface dose as dose delivered by IOBT

Material and methods
Two steps were taken to increase the surface dose for IOERT: 1. Introducing a bolus to achieve a maximum dose on the surface, and 2. Re-normalizing to allow for the same prescribed dose at reference depth

Conclusions
We describe and propose an adaptation of IOERT technique to increase surface dose, decreasing the differences between these two techniques, with the aim of further improving local control. In addition, an alternative method of dose prescription is suggested, to consider improved comparison with other techniques in the future.

keywords:

dose distribution, intraoperative radiotherapy, dosimetry, locally advanced rectal cancer, recurrent rectal cancer, surface dose, intraoperative electron radiotherapy, intraoperative brachytherapy