eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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4/2022
vol. 14
 
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abstract:
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

1.
Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
2.
GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
3.
Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
4.
Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
J Contemp Brachytherapy 2022; 14, 4: 370–378
Online publish date: 2022/07/21
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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

 
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