INTRAOPERATIVE RADIATION THERAPY FOR CHILDHOOD TUMORS
In childhood local tumor control is critical especially when a mass cannot be totally removed or residual disease cannot be treated effectively with other therapies. Treatment of these tumors may be problematic and is of greater importance in the pediatric population where mutilating surgery or high dose radiation may cause distressing consequences in developing soft tissues and bones. The role of radiation therapy in children is limited by poor tolerance of skin and normal tissues adjacent to the treatment area. However, in addition to other technical advances in surgical removal, the strategy of intraoperative radiation therapy allows a single large dose to be delivered to the tumor at the time of the operation. The radiation can be focused on a precise area and surrounding normal tissues can be protected.
Over 15 years of experience, we have developed specific surgical guidelines for these procedures. Because of their potential magnitude, the technical aspects applied in the operating room during patient transport and in the radiation therapy suite have been carefully undertaken. Despite the advanced stage or recurrent nature of the tumors every attempt is made for complete resection and intraoperative radiation therapy is used for residual disease or if the original area could not be adequately cleared. The surgeon and the radiation oncologist work together to maximize the potential advantages over conventional radiation therapy. The tumor area to be treated can be directly visualized during the operation and the radiation dose can be delivered directly to the target tissue. Radiosensitive normal structures in the area can be shielded and injury to skin, intestine, and bone marrow can be essentially eliminated.
Our experience represents the largest series of children treated with this modality in the world. To date more than 100 tumor fields have been treated with intraoperative radiation therapy. Our initial experience with more than four years follow up showed a local tumor control rate of 75% in cancerous lesions and 91% in benign tumors. The treatment has been used in a wide variety of lesions including neural tumors, sarcomas, kidney tumors, and several other lesions. The overall survival rate in recurrent cancers was 65%. A more recent evaluation with a six year follow up in the most difficult group of patients, those with advanced neuroblastoma, still showed that half the children were surviving their disease.
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