Eble M J, Kallinowski F, Wannenmacher M F, Herfarth C
Abteilung Klinische Radiologie, Universität Heidelberg.
Chirurg. 1994 Jul;65(7):585-92.
Intraoperative radiotherapy (IORT) offers a technique to increase radiation dose to the residual tumor or tumor bed while sparing neighboring radiosensitive organs. Beyond the mostly employed dedicated electron beam facilities, the afterloading--'flab'-technique was also used. In first prospective studies IORT was performed in patients with not completely resected locally advanced (T4) or recurrent tumors after complete external beam radiotherapy (50.4 Gy) as an additional boost dose, using small field sizes. This locally restricted dose escalation yielded higher local control and an increased prognosis. Nerves and ureters were dose limited. In our series IORT was performed for rectal carcinomas stages II and III. After an external beam radio- or radio-chemotherapy with 41.4 Gy, shrinking field boost irradiation was done intraoperatively with moderate doses and larger IORT field sizes. Compared to a historical control with high-dose external beam radiotherapy alone local control rate was increased. Radiogenic neuropathy or stenosis of the ureter was not observed. The impact on prognosis must awaited. Randomized studies are required to clearly describe the role of IORT in rectal carcinoma.
术中放疗（IORT）提供了一种增加对残留肿瘤或肿瘤床的辐射剂量，同时保护邻近放射敏感器官的技术。除了最常用的专用电子束设备外，还使用了后装——“平板”技术。在最初的前瞻性研究中，对于局部晚期（T4）未完全切除或在完成外照射放疗（50.4 Gy）后复发的肿瘤患者，使用小照射野尺寸进行IORT，作为额外的增敏剂量。这种局部受限的剂量递增产生了更高的局部控制率和改善的预后。神经和输尿管的剂量受到限制。在我们的系列研究中，对II期和III期直肠癌患者进行了IORT。在进行41.4 Gy的外照射放疗或放化疗后，术中进行中等剂量和更大IORT照射野尺寸的缩野增敏照射。与仅采用高剂量外照射放疗的历史对照相比，局部控制率有所提高。未观察到放射性神经病变或输尿管狭窄。对预后的影响尚待观察。需要进行随机研究以明确描述IORT在直肠癌中的作用。
