Delivery of intraoperative radiation therapy after pneumonectomy: experimental observations and early clinical results

Journal Article · Wed Jul 01 04:00:00 EDT 1987 · Ann. Thorac. Surg.; (United States)

DOI:https://doi.org/10.1016/S0003-4975(10)62346-6· OSTI ID:6071908

Pass, H I; Sindelar, W F; Kinsella, T J; DeLuca, A M; Barnes, M; Kurtzman, S; Hoekstra, H; Tochner, Z; Roth, J; Glatstein, E

Intraoperative radiation therapy (IORT) is capable of delivering high doses of radiation to mediastinal structures while sparing lung parenchyma, heart, and other locoregional tissues. A canine model of pulmonary resection and IORT was investigated by performing a pneumonectomy in 15 adult foxhounds followed by 0 cGy, 2000 cGy, 3000 cGy, 4000 cGy. No clinical complications developed in 4 animals in the 2000-cGy group. However, 2 of the 8 animals given a high dose died of esophageal hemorrhage or carinal necrosis. Esophagitis occurred in 10 of 12 animals, and none of the animals experienced bronchial stump dehiscence. In a limited Phase I protocol, 4 patients with non-small cell lung cancer were treated with resection and 2500 cGy of IORT to two separate ports encompassing the superior and inferior mediastinum. Two patients experienced life-threatening bronchopleural fistulas, and 2 patients died as a consequence of esophageal problems. One patients had recurrence with brain metastases, and the 1 long-term survivor is free from disease. As opposed to the animal model of thoracic IORT, the clinical study demonstrated major toxicity with respiratory and esophageal morbidity. The therapeutic usefulness of thoracic IORT in the management of lung cancer must be questioned in view of this small but consistent series of patients. Further carefully designed clinical studies using lower doses of IORT are needed.

• Research Organization: National Cancer Institute, Bethesda, MD
• OSTI ID: 6071908
• Journal Information: Ann. Thorac. Surg.; (United States), Journal Name: Ann. Thorac. Surg.; (United States) Vol. 44:1; ISSN ATHSA
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
ANIMALS
BIOLOGICAL MODELS
BODY
BODY AREAS
CHEST
DISEASES
DOGS
LUNGS
MAMMALS
MEDIASTINUM
MEDICINE
METASTASES
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
PATIENTS
RADIOLOGY
RADIOTHERAPY
RESPIRATORY SYSTEM
SIDE EFFECTS
SURGERY
THERAPY
VERTEBRATES