Calvo Felipe A, Meirino Rosa M, Orecchia Roberto
Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Crit Rev Oncol Hematol. 2006 Aug;59(2):116-27. doi: 10.1016/j.critrevonc.2006.04.004. Epub 2006 Jul 21.
Intraoperative radiation therapy (IORT) has been used for over 30 years in Asia, Europe and America as a supplementary activity in the treatment of cancer patients with promising results. Modern IORT is carried out with electron beams (IOERT) produced by a linear accelerator generally used for external beam irradiation (EBRT) or a specialized mobile electron accelerator. HDR brachytherapy (HDR-IORT) has also been applied on selected locations. Retrospective analysis of clinical experiences in cancer sites such as operable pancreatic tumour, locally advanced/recurrent rectal cancer, head and neck carcinomas, sarcomas and cervical cancer are consistent with local tumour control promotion compared to similar clinical experiences without IORT. New emerging indications such as the treatment of breast cancer are presented. The IORT component of the therapeutical approach allows intensification of the total radiation dose without additional exposure of healthy tissues and improves dose-deposit homogeneity and precision. Results of the application of IORT on selected disease sites are presented with an analysis on future possibilities. To improve the methodology, clinical trials are required with multivariate analysis including patient, tumour and treatment characteristics, prospective evaluation of early and late toxicity, patterns of tumour recurrence and overall patient outcome.
术中放射治疗（IORT）在亚洲、欧洲和美洲已应用超过30年，作为癌症患者治疗的一种辅助手段，取得了令人满意的效果。现代IORT采用直线加速器产生的电子束（IOERT）进行，这种直线加速器通常用于外照射放疗（EBRT），也可使用专门的移动式电子加速器。高剂量率近距离放射治疗（HDR - IORT）也已应用于特定部位。对可手术切除的胰腺肿瘤、局部晚期/复发性直肠癌、头颈癌、肉瘤和宫颈癌等癌症部位的临床经验进行回顾性分析，结果显示与未采用IORT的类似临床经验相比，IORT有助于促进局部肿瘤控制。文中还介绍了乳腺癌治疗等新出现的适应证。治疗方案中的IORT部分能够在不增加健康组织额外照射的情况下提高总辐射剂量，并改善剂量沉积的均匀性和精确性。本文展示了IORT在选定疾病部位的应用结果，并分析了未来的可能性。为改进方法，需要开展临床试验，进行多变量分析，包括患者、肿瘤和治疗特征，对早期和晚期毒性进行前瞻性评估，分析肿瘤复发模式以及患者的总体预后。
