Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases.

To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases. Diagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities. Eight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm Kilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.

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Copyright © 2021 Scafa, Muedder, Holz, Koch, Nour, Garbe, Gonzalez-Carmona, Feldmann, Vilz, Köksal, Giordano, Schmeel and Sarria.

Déclaration de conflit d'intérêts

DS has stocks from AstraZeneca GmbH. MG-C received travel expenses and honoraria from Bristol-Myers Squibb, Roche, MSD, IPSEN, Eisai, Amgen, and Servier not related to this work. FG received research grants and travel expenses from ELEKTA AB; grants, stocks, travel expenses, and honoraria from NOXXON Pharma AG; research grants, travel expenses and honoraria from Carl Zeiss Meditec AG; travel expenses and honoraria from Bristol-Myers Squibb, Roche Pharma AG, MSD Sharp and Dohme GmbH and AstraZeneca GmbH; non-financial support from Oncare GmbH and Opasca GmbH, not related to this work. LS GS received personal fees from Carl Zeiss Meditec AG, personal fees from Roche Pharma AG, personal fees from MedWave Clinical Research BV, and travels expenses from Guerbet GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.