Intraoperative radiation therapy in the multimodality approach to hepatobiliary tract cancer.
IOERT is a reasonable option to consider in patients who have biliary tract cancers above AJCC or Bismuth stage I disease. Inherent resistance of biliary tract cancer cells to ionizing radiation would indicate that IOERT alone would not eradicate most of the tumor clonagen. EBRT (either preoperatively or postoperatively) should be used in combination with IOERT at experienced institutions that have access to both modalities. The single IOERT dose ranges are 10 to 20 Gy [55,67], whereas the EBRT dose ranges from 45 to 50 Gy in 25 to 28 fractions [67]. The most common energy level used is 8 MeV or less. In addition, IOERT port sizes of less than 6 cm in diameter, and often 4 cm or less, are recommended. Finally, intraoperative reconstruction of severely damaged blood vessels may decrease the clinical manifestation of radiation-induced injury to vessels [68].
Thomas
Charles R
CR
Department of Radiation Oncology, Division of Medical Oncology, Department of Medicine, University of Texas Health Science Center, San Antonio, San Antonio Cancer Institute, San Antonio, TX, USA. cthomas@saci.org
Merrick
Hollis W
HW
D000230:Adenocarcinoma / Q000175:diagnosis / Q000503:physiopathology* / Q000532:radiotherapy* / Q000601:surgery; D001659:Biliary Tract / Q000528:radiation effects; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000503:physiopathology* / Q000532:radiotherapy* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D003131:Combined Modality Therapy; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007432:Intraoperative Period; D008099:Liver / Q000528:radiation effects; D008113:Liver Neoplasms / Q000175:diagnosis / Q000503:physiopathology* / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000379:methods*