Intraoperative radiation therapy in the combined treatment of operable lung cancer. Review

«Radiation and Risk», 2024, vol. 33, No. 1, pp.120-135

DOI: 10.21870/0131-3878-2024-33-1-120-135

Authors

Mokh A.A. – Intern. Contacts: 12/1 Savinykh str., Tomsk, Tomsk region, Russia, 634028. Tel.: +7 (923) 411-19-59; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Rodionov E.O. – Sen. Researcher, C. Sc., Med., Assistant of Dep. of SSMU
Miller S.V. – Lead. Researcher, MD
Kondakova I.V. – Head of lab., MD, Prof.
Sidenko E.A. – Res. Assistant, C. Sc., Med.
Startseva J.A. – Head of Dep., MD, Prof.
Pankova O.V. – Sen. Researcher, D. Sc., Biol.
Loos D.M. – Pathologist, Assistant of Dep. of SSMU
Tsyganov M.M. – Sen. Researcher, C. Sc., Med.
Zhuikova L.D. – Head of lab., MD
Litvyakov N.V. – Head of lab., MD, Prof. of RAS. Cancer Research Institute – Tomsk NRMC.
1 Cancer Research Institute – Tomsk National Research Medical Center of the RAS, Tomsk
2 Siberian State Medical University of the Ministry of Health of Russia, Tomsk

Abstract

The treatment of non-small-cell lung cancer (NSCLC) continues to be a pressing issue. It is therefore necessary to advance and to put into practice the methods that will improve patients survival. The aim of the study was to estimate available information on application of intraoperative radiation therapy (IORT) in combined treatment of patients with NSCLC. The treatment plans, safety and tolerability of the treatment method were evaluated. From data analysis it became clear that IORT is a topical treatment for operable non-small cell lung cancer (NSCLC). The new technology has proved its effectiveness due to the reliable local control and significant improve the late survival of patients. During the IORT high one-off dose is selectively delivered to the tumor or tumor bed with maximum preservation of the adjacent normal tissues. The key point in planning radiation exposure during the IORT is to calculate accurately the single radiation dose. The reduction of local relapses and the improvement in overall survival are most likely due to the IORT damaging effect on possible tumor microfoci located in the bronchus cult, its surrounding tissues and lymphatic outflow pathways. To date, further study of the IORT effectiveness and feasibility will remain relevant. However, intraoperative irradiation has already proved to be an effective component of a multimodal approach to cancer treatment.

Key words
oncology, radiation therapy, intraoperative radiation therapy, non-small cell lung cancer, local lung cancer, combination treatment, linear accelerators, radiation technique, postoperative complications, local relapse, overall survival, radiology, nuclear medicine and imaging.

References

1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global cancer statis-tics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin., 2021, vol. 71, no. 3, pp. 209-249.

2. Sostoyaniye onkologicheskoĭ pomoshchi naseleniyu Rossii v 2021 godu [The state of oncological care to the population of Russia in 2021]. Eds.: A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. Moscow, P. Hertsen MORI, 2022. 239 p.

3. Zlokachestvennyye novoobrazovaniya v Rossii v 2015 godu (zabolevayemost’ i smertnost’) [Malignant neo-plasms in Russia in 2015 (morbidity and mortality)]. Eds.: A.D. Kaprin, V.V. Starinsky, G.V. Petrova. Moscow, P. Hertsen MORI, 2017. 250 p.

4. Zhou G., Zeng T., Wang L., Ma L. Analysis of the long-term effect of intraoperative radiotherapy (IORT) for non-small cell lung carcinoma (NSCLC). Chin. J. Clin. Oncol., 2007, vol. 4, no. 1, pp. 65-70.

5. Willich N. Technical and methodical developments of radiation oncology from a physician’s point of view. Strahlenther. Onkol., 2012, vol. 188, no. 3 (Suppl.), pp. 253-262.

6. Biggs P.J., Epp E.R., Ling C.C., Novack D.H., Michaels H.B. Dosimetry, field shaping and other consider-ations for intra-operative electron therapy. Int. J. Radiat. Oncol. Biol. Phys., 1981, vol. 7, no. 7, pp. 875-884.

7. Johnson M., Colonias A., Parda D., Trombetta M., Gayou O., Reitz B., Miften M. Dosimetric and technical aspects of intraoperative I-125 brachytherapy for stage I non-small cell lung cancer. Phys. Med. Biol., 2007, vol. 52, no. 5, pp. 1237-1245.

8. Ter-Ovanesov M.D., Kukosh M.Yu. Intraoperative radiation therapy: yesterday, today, future (literature review). Meditsinskiy alfavit – Medical Alphabet, 2017, vol. 3, no. 35, pp. 23-28. (In Russian).

9. Beddar A.S. Stability of a mobile electron linear accelerator system for intraoperative radiation therapy. Med. Phys., 2005, vol. 32, no. 10, pp. 3128-3131.

10. Calvo F.A., Aristu J., Serrano J., Cambeiro M., Martinez-Monge R., Cañón R. Intraoperative radiotherapy in lung cancer: methodology (electrons or brachytherapy), clinical experiences, and long-term institutional re-sults. In: Advances in radiation oncology in lung cancer. Medical Radiology. Ed.: B. Jeremić. Springer, Berlin, Heidelberg, 2022, pp. 605-621.

11. Intraoperative radiation therapy (1st ed.). Eds.: Jr.R.R. Dobelbower, M. Abe. New York, CRC Press, 1989. 432 p.

12. Intraoperative radiation therapy. Clinical experiences and results. Eds.: F.A. Calvo, M. Santos, L.W. Brady. Berlin, Springer, 1992. 160 p.

13. Calvo F.A. Intra-operative radiotherapy: a developmental technique for loco-regional intensification of cancer treatment. Pathol. Biol., 1992, vol. 39, no. 9, pp. 883.

14. Calvo F.A., Ortiz de Urbina D., Abuchaibe O., Azinovic I., Aristu J., Santos M., Escude L., Herreros J., Llorens R. Intraoperative radiotherapy during lung cancer surgery: technical description and early clinical results. Int. J. Radiat. Oncol. Biol. Phys., 1990, vol. 19, no. 1, pp. 103-109.

15. Zeng D.W., Chang Q.S., Sun Y.E. IORT for non-small cell lung cancer: preliminary report of 33 cases. Front. Radiat. Ther. Oncol., 1997, vol. 31, pp. 138-139.

16. Carter Y.M., Jablons D.M., DuBois J.B., Thomas C.R.Jr. Intraoperative radiation therapy in the multimodality approach to upper aerodigestive tract cancer. Surg. Oncol. Clin. N. Am., 2003, vol. 12, no. 4, pp. 1043-1063.

17. Ott P.A., Privalov A.V., Vazhenin A.V., Nadvikova E.A., Lukina E.Yu., Komissarov A.V., Zabolotskaya E.G. Immediate results of combined treatment with intraoperative radiation therapy of soft tissue sarcomas. Voprosi onkologii – Problems in Oncology, 2013, vol. 59, no. 5, pp. 603-605. (In Russian).

18. Choinzonov E.L., Musabayeva L.I., Lisin V.A. Intraoperative radiation therapy in the combined treatment of malignant neoplasms. Materials of the X Russian Cancer Congress. Moscow, 2006. (In Russian).

19. Surova O., Zhivotovsky B. Various modes of cell death induced by DNA damage. Oncogene, 2013, vol. 32, no. 33, pp. 3789-3797.

20. Eriksson D., Stigbrand T. Radiation-induced cell death mechanisms. Tumour Biol., 2010, vol. 31, no. 4, pp. 363-372.

21. Stewart R.D., Yu V.K., Georgakilas A.G., Koumenis C., Park J.H., Carlson D.J. Effects of radiation quality and oxygen on clustered DNA lesions and cell death. Radiat. Res., 2011, vol. 176, no. 5, pp. 587-602.

22. Minafra L., Bravatà V. Cell and molecular response to IORT treatment. Transl. Cancer Res., 2014. vol. 3, no. 1, pp. 32-47.

23. Herskind C., Ma L., Liu Q., Zhang B., Schneider F., Veldwijk M.R., Wenz F. Biology of high single doses of IORT: RBE, 5 R's, and other biological aspects. Radiat. Oncol., 2017, vol. 12, no. 1, pp. 24.

24. World Congress on Medical Physics and Biomedical Engineering, September 7-12, 2009, Munich, Germany. Berlin, Heidelberg, Springer, 2009. 716 p.

25. Grass G.D., Krishna N., Kim S. The immune mechanisms of abscopal effect in radiation therapy. Curr. Probl. Cancer, 2016, vol. 40, no. 1, pp. 10-24.

26. Linares-Galiana I., Berenguer-Frances M.A., Cañas-Cortés R., Pujol-Canadell M., Comas-Antón S., Martínez E., Laplana M., Pérez-Montero H., Pla-Farnós M.J., Navarro-Martin A., Nuñez M., Both B., Guedea F. Changes in peripheral immune cells after intraoperative radiation therapy in low-risk breast cancer. J. Radiat. Res., 2021, vol. 62, no. 1, pp. 110-118.

27. Pevzner A.M., Tsyganov M.M., Ibragimova M.K., Litvyakov N.V. Abscopal effect in the radio and immuno-therapy. Radiat. Oncol. J., 2021, vol. 39, no. 4, pp. 247-253.

28. Zavyalov A.A., Musabaeva L.I., Lisin V.A., Choynzonov E.L., Novikov V.A., Kolomiyets L.A., Tuzikov S.A., Afanas’yev S.G., Dubskiy S.V., Anisenya I.I., Tyukalov Yu.I., Miller S.V., Dobrodeyev A.Yu., Chivchish L.N., Nechitaylo M.N., Zheravin A.A. Fifteen years of experience in the use of intraoperative radiation therapy. Sibirskiy onkologicheskiy zhurnal – Siberian Journal of Oncology, 2004, no. 2-3, pp. 75-84. (In Russian).

29. Novikov V.A., Vasiliev R.V., Choynzonov E.L., Lisin V.A., Musabaeva L.I., Gribova O.V., Surkova P.V., Shtin V.I., Ryabova A.I. Intraoperative radiation therapy: reality and perspective. Zlokachestvennyye opukholi – Malignant Tumours, 2017, vol. 7, no. 3, sp. issue 1, pp. 35-40. (In Russian).

30. Zyryanov B.N., Chahlov V.L., Hodkevich B.S., Anisenya I.I. Intraoperative irradiation of tumours. Voprosi onkologii – Problems in Oncology, 1992, vol. 38, no. 5, pp. 131-135. (In Russian).

31. Zyryanov B.N., Afanas’yev S.G., Zav’yalov A.A. Intraoperative radiation therapy in the combined treatment of patients with lung cancer and stomach cancer. Sibirskiy onkologicheskiy zhurnal – Siberian Journal of Oncology, 2002, no. 1, pp. 19-24. (In Russian).

32. Miller S.V. Modern possibilities of combined treatment of locally advanced non-small cell lung cancer and correction of postoperative operations: autoref. diss. doc. sci. med. Tomsk, 2009. 225 p. (In Russian).

33. Dobrodeev A.Yu., Lisin V.A., Zavyalov A.A., Tuzikov S.A., Musabaeva L.I., Miller S.V. Intraoperative ra-diation therapy in combined modality treatment for stage iii non-small cell lung cancer: maximum single dose and incidence of radiation induced reactions and complications. Meditsinskaya radiologiya i radiatsionnaya bezopasnost’ – Medical Radiology and Radiation Safety, 2010, vol. 55, no. 4, pp. 41-48. (In Russian).

34. Pankova O.V., Tashireva L.A., Rodionov E.O., Miller S.V., Gerashchenko T.S., Pisny D.S., Zavyalova M.V., Denisov E.V., Perelmuter V.M. Effectiveness of preoperative therapy in groups with high and low risk of hematogenous metastasis in squamous cell carcinoma and lung adenocarcinoma. Sibirskiy onkologicheskiy zhurnal – Siberian Journal of Oncology, 2022, vol. 21, no.6, pp. 25-37. (In Russian).

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