Goldson A L, Streeter O E, Ashayeri E, Collier-Manning J, Barber J B, Fan K J
Cancer. 1984 Dec 1;54(11 Suppl):2807-13. doi: 10.1002/1097-0142(19841201)54:2+<2807::aid-cncr2820541428>3.0.co;2-b.
Intraoperative radiotherapy (IOR) or "direct view" irradiation permits the delivery of a single exposure of high-energy electrons to a surgically exposed tumor. Surgical exposure permits physical retraction of normal uninvolved tissues away from the IOR beam as well as the accurate assessment of the target volume. IOR represents a "supplement" or "boost" dose to conventional fractionated external beam irradiation that is administered postoperatively. This pilot study represents the clinical experience in the US using IOR for brain tumors. At Howard University Hospital, Washington, DC, 12 patients underwent surgical resection or decompression and 1500 cGy were delivered to the tumor bed intraoperatively. After surgical recovery, 5000 cGy in 25 fractions were delivered to the whole brain and an additional 500 cGy cone-down boost were delivered to the tumor bed. This protocol was best tolerated when the cranial vault was decompressed. Two patients with meningioma are without evidence apparently NED at 8, 11, 12, and 15 months, respectively. A fifth patient died at 8 months NED from an accident. Three glioma patients died with disease at 3, 13, and 15 months, respectively. Two additional patients died 30 days after surgery. Indications, techniques, and clinical findings are presented.
术中放疗（IOR）或“直视”照射允许将单次高能电子照射传递到手术暴露的肿瘤。手术暴露可使未受累的正常组织从IOR射束物理性回缩，以及对靶体积进行准确评估。IOR是对术后进行的传统分次外照射的“补充”或“增强”剂量。这项初步研究代表了美国使用IOR治疗脑肿瘤的临床经验。在华盛顿特区的霍华德大学医院，12例患者接受了手术切除或减压，并在术中向肿瘤床给予1500 cGy照射。术后恢复后，对全脑给予25次分割共5000 cGy照射，并向肿瘤床额外给予500 cGy的缩野增强照射。当颅骨减压时，该方案耐受性最佳。两名脑膜瘤患者分别在8个月、11个月、12个月和15个月时无疾病证据，显然处于无疾病生存状态。第五例患者在无疾病生存8个月时死于意外事故。三名胶质瘤患者分别在3个月、13个月和15个月时死于疾病。另外两名患者在术后30天死亡。本文介绍了适应证、技术和临床发现。
