ABSTRACT
BACKGROUND AND OBJECTIVES: The low availability and poor access to external beam radiotherapy (EBRT) in developing countries makes it hard for women with breast cancer to receive breast conservation. We studied the effect of providing intraoperative radiotherapy (IORT) on the travel time, distance, and costs of in the Mexico City Metropolitan Area (MCMA). METHODS: Sixty-nine patients treated between January 2013 and September 2014 were analyzed. Travel distance and transit time was calculated using Google Maps. The time and distance patients living in the MCMA treated with IORT would have spent if they had received EBRT was calculated. Cost analysis for each modality was performed. RESULTS: 71% (n = 49) lived in the MCMA. Sixteen (33%) received additional EBRT and 33 (66%) received IORT only. Mean driving distance and transit time of those 33 women was 132.6 km (SD 25.7) and 66 min (SD 32.9). Patients from the MCMA receiving IORT alone avoided 990 visits, 43 700 km and 65 400 min in transit. IORT led to a 12% reduction in costs per patient. CONCLUSIONS: By reducing costs and time needed for patients to receive radiotherapy, IORT could potentially enhance access to breast conservation in resource-limited developing countries.
Subject(s)
Breast Neoplasms/economics , Breast Neoplasms/therapy , Health Services Accessibility/economics , Travel/economics , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Combined Modality Therapy , Developing Countries , Female , Health Care Costs , Humans , Intraoperative Care/economics , Intraoperative Care/methods , Mexico , Middle Aged , Radiotherapy/economics , Radiotherapy/methods , Time FactorsABSTRACT
Objective To investigate the safety of intraoperative electron radiation therapy (IOERT) for stage Ⅰ hepatocellular carcinoma (HCC) by a cohort study.Methods From November 2010 to May 2012,16 patients who were pathologically diagnosed with stage Ⅰ HCC underwent IOERT after radical resection.With a cohort study,87 patients with stage Ⅰ HCC who underwent radical resection alone during the same period were qualified,and according to tumor size (＞ 5 cm and ≤ 5 cm) and resection margin (close margin and negative margin),32 of 87 patients made up the control group.The intraoperative and postoperative adverse events,liver function parameters,coagulogram,and routine blood parameters,as well as IOERT-related adverse reactions,were evaluated.Independent-samples t test was used for analyzing the differences between groups.Results Compared with the control group,the IOERT group had a significantly longer operative time ((275.4 ± 71.55) min vs.(184.7 ± 64.74) min,P =0.000),a slightly higher incidence of intraoperative adverse events (18.75％ vs.6.25％,P=1.000),a slightly lower incidence of operative complications (12.50％ vs.28.12％,P =0.460),and a lower perioperative mortality (0 vs.6％,P =0.440).Liver function parameters showed no significant differences between the two groups (P ＞ 0.05).There were no significant differences between the two groups in postoperative time to grade 1 or normal liver function parameters,median length of postoperative hospital stay,length of hospital stay in the surgical department,time to incision healing,and level of incision healing (P ＞ 0.05).During follow-up,no radiation hepatitis was found in the IOERT group.Conclusions As an adjuvant therapy after radical resection for early HCC,IOERT has no significant side effects on postoperative recovery and liver function,and an intraoperative dose of 15-16 Gy is safe.
ABSTRACT
Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.
ABSTRACT
Objective To analyse the long-term effect of non-small cell lung cancer treated with either postoperative irradiation(group A) or intraoperative radiotherapy(IORT) followed by postoperative irradiation(group B).Methods 154 patients with non-small cell lung carcinoma were randomized into two groups(groups A and B) with 77 patients in each.There were 134 squamous,17 adenocarcinoma and 3 adeno-squamous carcinoma.Seventeen patients had stage Ⅰ,76 stage Ⅱ and 61 stage Ⅲ lesions.The dose of postoperative irradiation in both groups was D_T4060?Gy.In group B,the IORT dose was 15-25?Gy,delivered by 9-16 ?MeV electrons.Results The local control rate was 49% and 62% in groups A and B,respectively(P0.05).Sixteen patients died of radiotherapy-induced complication: 2 in group A and 14 in group B.Conclusions Intraoperative radiotherapy followed by postoperative irradiation can enhance the local control rate of non-small cell lung cancer but can not improve the long term survival. The high complication mortality rate of IORT(18%) in contrast to that(3%) of postoperative radiotherapy is worth noticing.
