Post on 13-Oct-2018
ESTRO-ACROP-based IORT guidelines: contents + dates + authors
EXPECTED DATES
CANCER SITES/TYPES RESPONSIBLE AUTHORS
15.09.2017 proposal FC, PP 15.10.2017 all authors circulation 15.11.2017 pre-definitive all topics 15.12.2017 definitive manuscript
BREAST CANCER APBI Boost
FS CL ES
15.09.2017 proposal FC, PP 15.10.2017 all authors circulation 15.11.2017 pre-definitive all topics 15.12.2017 definitive manuscript
RECTAL CANCER
cT4 cN+ (?) Oligorecurrent
HR CS
15.09.2017 proposal FC, PP 15.10.2017 all authors circulation 15.11.2017 pre-definitive all topics 15.12.2017 definitive manuscript
PANCREATIC CANCER Resected Border-line Urresected
FC MK
15.09.2017 proposal FC, PP 15.10.2017 all authors circulation 15.11.2017 pre-definitive all topics 15.12.2017 definitive manuscript
SOFT TISSUE SARCOMAS Extremity Retroperitoneal Trunk/Central (?)
FR CF
(?) take a decision on inclusion or not of these sub-categories. FR: Falk Roeder; CF: Carlos Ferrer; MJ: Marta Jayes; PP: Philip Poortmans; FC: Felipe Calvo; FS: Felix Sedlmayer; ES: Elena Sperk; CL: Cristina Leonardi; CS: Claudio Sole; MK: Marco Krengli; HR: Harm Rutten
ESTRO-IORT Working Group/Task Force Timeline (after 2017 ESTRO meeting to December 2017)
FR: Falk Roeder; CF: Carlos Ferrer; MJ: Marta Jayes; PP: Philip Poortmans; FC: Felipe Calvo; FS: Felix Sedlmayer; ES: Elena Sperk; CL: Cristina Leonardi; CS: Claudio Sole; MK: Marco Krengli; HR: Harm Rutten
INVOLVED MEMBERS
ACTION STATUS
MJ ESTRO office provide ACROP latest guidelines and minutes from 07.05.2017 meeting Received FC May 2017
FC ACROP Guidelines + recommendations (FC) circulation among responsible authors Done 01.06.2017
FC, MK, HR,CS,FS, CL,ES,FR,CF
Elaboration proposal guidelines (ACROP based) by site/type and sent to FC + PP
Expected 15.09.2017
FC, MK, HR,CS,FS, CL,ES,FR,CF,PP
Review (FC + PP) and re-circulation all authors/all guidelines for comments Expected 15.10.2017
FC, MK, HR,CS,FS, CL,ES,FR,CF,PP
Working groups by cancer site/type submit a pre-definitive draft of guideline Agree already 15.11.207
FC, MK, HR,CS,FS, CL,ES,FR,CF,PP
Definitive manuscripts available from all groups Agree already 15.12.2017
PP FC MJ
Submission to ACROP Agree already 31.12.2017
EBRT: external beam radiotherapy; CT: chemotherapy; Gy: Gray; Kv: Kilovoltaje
Table 1. Chronologic data analysis from a 25 years literature review period on IORT for
pancreatic cancer: unresectable disease (33 articles, 1.866 patients) or post- resected status (27 articles,
1.234 patients)
DISEASE STATUS
1981-1989
1990-1999
200-2009 2010-2016
UNRESECTABLE
# Studies
# Patients
References
11
446
24-34
11
374
35-45
8
670
46-53
3
376
22, 54-55
IORT
Dose range (Gy)
Mean dose (Gy)
Electron beam
10-40
20
100%
10-40
20
100%
10-30
20
100%
10-30
20
100%
EBRT delivered
> 50% pts
27 %
54%
87%
75%
Adjuvant CT
> 50% pts
36%
36%
50%
100%
Median Survival
Range (months)
Mean (months)
8-16
10
3-18
10
7-13
11
9-16
13
RESECTED
# Studies
# Patients
References
4
37
31,34,37,56
11
253
18,35,38,42,58,63
8
606
48,52,64,69
4
338
17,23,54,70
IORT
Dose range (Gy)
Mean dose (Gy)
Electron beam
250 Kv
10-40
25
100%
--
10-30
15
100%
--
10-25
15
100%
--
6-30
15
75%
25%
EBRT delivered
> 50% pts
75%
40%
75%
75%
Adjuvant CT
> 50% pts
25%
63%
75%
100%
Median Survival
Range (months)
Mean (months)
5-18
9,5
10-19
15
9-28
15
19-24
21
25 years
>3,000 patients
>60 publications
MGH: Massachusetts General Hospital
(*) Entire group
Table 3. Institutional contemporary experiences including IOERT component in unresectable/borderlilne
disease treated with neoadjuvant chemoradiation with or without induction FORFIRINOX.
PARAMETER
MAYO CLINIC 2013 (21)
MGH 2016 (20)
Period of analysis
2002 - 2010 2010 - 2015
Initial local status:
Unresectable
Borderline
Median T size
37 (77%)
11 (23%)
--
60 (88%)
8 (12%)
3,6 cm
Neoadjuvant therapy
Chemo-radiation
Induction FORFIRINOX
31
--
68
68
Resected
# patients
R0
R1
R2
17 (35%)
11 (64%)
5 (29%)
1 (5%)
41 (68%)
19 (46%)
16 (39%)
6 (14%)
IOERT
# patients
Dose range
28 (58%)
12.5 – 20Gy
16 (26%)
10 – 17Gy
Outcomes for resection + IOERT
Local control
Median OS
3 years OS
84% (*)
+ 20 months
+ 30% (*)
73.8%
35.1 months
+ 40%
Post 2000- Post-neadjuvant
125 patients >3 years OS… +30%
Target volumen description
Tumor residue
Normal tissues exposed
Normal tissues protected/movilized
Special conditions:
Vascular manipulation Others
IORT factors
Applicator size /diameter Beveled end (degrees)
Electron energy Isodose prescription
Total dose
Number of fields Report every parameter for every field Overlaping Field –within-a-field
Protections
Fluid stability
Time of beam on
Gantry angulation
In vivo dosimetry (system/site)
Integrated pre-IORT treatment factors
Surgery: type of resection /exposure Neoadyuvant
Chemoradiation (CRT) Induction chemotherapy + CRT
Table 3. Reporting parameters for IORT electrons beam procedures in pancreatic cancer.
ESTRO-IORT Working Group/Task Force Timeline (after 2017 ESTRO meeting to December 2017)
FR: Falk Roeder; CF: Carlos Ferrer; MJ: Marta Jayes; PP: Philip Poortmans; FC: Felipe Calvo; FS: Felix Sedlmayer; ES: Elena Sperk; CL: Cristina Leonardi; CS: Claudio Sole; MK: Marco Krengli; HR: Harm Rutten
INVOLVED MEMBERS
ACTION STATUS
MJ ESTRO office provide ACROP latest guidelines and minutes from 07.05.2017 meeting Received FC May 2017
FC ACROP Guidelines + recommendations (FC) circulation among responsible authors Done 01.06.2017
FC, MK, HR,CS,FS, CL,ES,FR,CF
Elaboration proposal guidelines (ACROP based) by site/type and sent to FC + PP
Expected 15.09.2017
FC, MK, HR,CS,FS, CL,ES,FR,CF,PP
Review (FC + PP) and re-circulation all authors/all guidelines for comments Expected 15.10.2017
FC, MK, HR,CS,FS, CL,ES,FR,CF,PP
Working groups by cancer site/type submit a pre-definitive draft of guideline Agree already 15.11.207
FC, MK, HR,CS,FS, CL,ES,FR,CF,PP
Definitive manuscripts available from all groups Agree already 15.12.2017
PP FC MJ
Submission to ACROP Agree already 31.12.2017