Transoral surgery and neck dissection with deintensified risk-based post-operative management increases efficacy in oropharynx cancer
3 Jun 2024
I’m at ESTRO because we are presenting three papers, one multi-institutional, showing our results in paediatric patients, especially Ewing’s sarcoma and rhabdomyosarcoma, showing that IORT, our approach with multi-modal treatment with IORT, is fundamental for local control.
We have another paper for T4 rectal cancer showing that even further there are some adverse factors for these types of tumours. We can get a good local control with IORT combined with chemotherapy and good surgery.
Finally, we have another paper for locally recurring oligorecurring pelvic cancer also showing the results of our institution with a large number of patients from different tumours including rectal cancer, gynaecological cancer and sarcomas. Also showing that IORT is important for local control and showing some adverse features that could select patients for intensive treatment containing not only IORT but EBRT as well.
How do you do IORT?
The way we do IORT is very different now because we just acquired a LinAcc which is a miniaturised mobile unit only for IORT. So we have a special operating room which is inside our service. It’s used every day and now we have the machine we do the whole treatment inside our service. Previously we had to move the patient outside, to the normal linear accelerators but now this has changed a lot. We do it for many, many types of tumours but especially rectal cancers and gynaecological cancers. So with that machine and special applicators and we irradiate the zone that we consider that is at more risk of recurrence.
How does surgery and IORT work together?
Usually the patient is operated and we talk about what’s the sum of higher risk of recurrence and we apply the IORT treatment with our new machine and then the surgeon finishes the whole procedure. We are seeing now a higher need of the surgeons to get this treatment because we have a cure list that is increasing almost every month. So it’s becoming now very popular. Now we have also our hospital has developed a virtual treatment planning system for only IORT which is being increasingly used and now is commercially available. We’ve known that some countries are acquiring the system as well.
Have you done randomised trials in pelvis or rectum, as we’ve seen in breast?
No, we haven’t done randomised controlled trials. It’s a difficult thing to do a randomised trial in IORT, there are not so many centres doing it. But that’s the way to go to make this technique more popular.
