Russell G. Schonberg: The History of the Portable Linear Accelerator
The History of the Portable Linear Accelerator
Introduction: The light weight mobile accelerator now being used in two medical
systems had its' genesis in the industrial world. In the 1970s there were numerous
nuclear power plants being built and several systems, which had some years of life and
were developing some evidence of failure in piping welds and valve malfunctions. Due
to the background radiation level in plants, which had been in operation, it was not
feasible to use isotopic sources to do radiography. In 1978 EPRI awarded Schonberg
Research Corporation a study contract to assess the feasibility of designing and
manufacturing a light weight portable accelerator of sufficient energy and flux density to
produce usable radiographs in an environment that had contact background levels of up
to 15 cGy/hr on piping. Pipe walls of 1-2 inches of stainless steel on 20-inch diameter
pipe, water filled needed to be inspected. The study resulted in a proposal to build a 4
MeV traveling wave accelerator using a magnetron r.f. source operating 9.3 GHz, with a
design dose rate of 100 cGy/m/m. The entire system was to be portable, to the extent that
two people could manually move the radiation source and associated hardware into
containment and move up and down ladders. The resulting system met the criteria and
first generated x-rays on December 31, 1979 (Figure 1).
The accelerator was originally packaged with the magnetron r.f. source and associated
pulse transformer. The total weight was marginal for two people at about 190 pounds,
but it did function and provided proof of principle. Subsequent design changes produced
a 6 MeV standing wave accelerator unit capable of producing 300 cGy/m/m. The
accelerator was separated from the r.f. source and flexible waveguide and cables allow
operation of the accelerator up to 20 feet from the r.f. source. The accelerator and
collimator weigh 90 pounds and have dimensions of 5 x 7 x 23 inches. The upgraded
unit is the design type manufactured currently for use on the Accuray robot arm mounted
system.
The History of the Medical Accelerator Unit: In 1989, SRC was approached by a
Neurosurgeon from Stanford University Medical Center. Dr. John Adler had been
treating patients with radiation for several years. He had used the Gammaknife in
Stockholm and other accelerator based systems to perform radiosurgery. He had come to
Stanford hoping to find a method of treatment whereby aiming accuracy would be
improved to reduce healthy tissue damage and increase the ratio of damage to the target
tissue versus healthy tissue. The use of X-band technology provided a physically
compact, light weight system, which could be accommodated on existing programmable
robot arms. The computer controlled aiming design fit the criteria to enable updating
retargeting during treatment. This in turn removes the requirement for a rigid head frame
to maintain the target accuracy. The result reduced patient discomfort and enables
fractionated dose treatment.
SRC applied for and received a Phase I SBIR for a feasibility study to assess the
practicality of the envisioned system (Figure 2). The study resulted in the actual
construction of the hardware, which would need to mount on the robot arm. This assured
us that we could fit within the weight and size constraints for robot arm mounting. Two
innovative design concepts aided in making this possible. The first was to change the
pulse transformers conventionally used from oil insulated to air insulated. This was
possible due to the unique winding configuration, with the high voltage winding on the
inside and the low voltage winding on the outside. The second innovation was one that
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Russell G. Schonberg: The History of the Portable Linear Accelerator
had been developed on the industrial units. Namely, to use an extended electron beam
target and reentrant collimator. This reduced weight of the primary beam collimator by
roughly a factor of three (Figure 3).
The accelerator subsystem is designed and manufactured by High Energy System
Division of American Science & Engineering, Inc. The overall systems integration and
all of the guidance software is designed and manufactured by Accuray Oncology, Inc.
The system employs a 6 MeV accelerator mounted on a 6 axis robot arm capable of
moving isocentrically about a treatment region in any chosen direction while maintaining
a constant target to treatment distance. The absolute aiming error is 0.7mm rms. In
addition to providing an extremely accurate energy deposition, the system employs two
low energy diagnostic x-ray units and two amorphous silicon detector panels to take
position-sensing images every few seconds. The resultant images are then correlated to a
family of CT images generated earlier for treatment planning (ref. 1). Any discrepancy
between images is detected and the robot is automatically retargeted to maintain absolute
registration (Figure 4).
Another feature is the ability to treat irregular fields by programming non-spherical
geometry with minimum penumbra. This is possible using small apertures and a paint
brush approach in three dimensions. The treatment time is increased using this
technique, but generally is well tolerated, and the healthy tissue damage is minimized.
The most recent improvement in medical application has been the treatment of lung and
peritoneal tumors. The movement of tumors in these regions has made conventional
treatment methods very difficult and not very effective. Using carefully targeted beam
geometry and gating the radiation to match the movement, an effective radiation therapy
modality is under development. Early results are very promising in controlling the beam
deposition and reducing collateral healthy tissue damage.
The original protocols were limited to head and neck; these have now been extended to
include other regions of the body. The following is a partial list of treatment types, which
have been performed using the Cyberknife.
• Intracranial Tumors and Lesions
h Cavernous Malformations
• Malignant Tumors
hFunctional Disorders
• Primary (astrocytomas, carcinomas, gliomas)
hTrigeminal Neuralgia
• Metastases (secondary growths)
hExtracranial Tumors, Lesions
• Benign Tumors
hBase of Skull
• Acoustic Neuromas
hNeck
• Schwannomas
hCervical Spine
• Meningiomas
hThoracic Spine*
• Pituitary Adenomas
hLumbar Spine*
• Vascular Malformations
• Arteriovenous Malformations (AVM's)
* Treated under Investigational Device Exemption (IDE) granted by FDA.
Intraoperative Therapy: The second type of cancer therapy unit is produced using the
same basic microwave source and electronics for the accelerator. This system is used to
provide electron beam treatment only. The concept for this device came about through
the collaboration of Dr. Jerry Vaeth, Radiation Oncologist (deceased), Gene Haynes, and
the author. The small size and weight of the system designed for industrial use was
known to Gene Haynes, and through discussions with Dr. Vaeth and the author, the idea
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Russell G. Schonberg: The History of the Portable Linear Accelerator
that a mobile unit might be designed to produce an electron beam for intra-operative
treatment of tumor sites was born (Figure 5).
An SBIR Phase I grant was processed with NIH. The primary issue was whether a high
energy electron beam unit could be safely operated in a non-shielded environment,
namely the surgery suite. Early test results with a 6 MeV system operating with an
electron beam only gave promising results. A Phase II SBIR was received and an X-band
prototype unit capable of operating at energies from 4 to 11 MeV was designed and built
with a favorable conclusion at the end of the Phase II SBIR. A decision was made in
1994 to form a new company to refine the design and market the system. Dr. Donald
Goer formerly serving as President of SRC formed the new company with the name of
Intraop Medical. Dr. Goer is currently the CEO of Intraop Medical, Inc. The
manufacture of the system was transferred to Siemens Medical, except for the X-band
accelerator guides, which are manufactured by the High Energy Systems Division of
American Science & Engineering. The test results at suitable dose rates and energies
resulted in leakage rates that were within acceptable levels (Ref. 2). At this stage a fullscale mobile system was designed and built by SRC. The initial system is in service at
UCSF and has used the system to treat all the UCSF IORT patients since 1998. The
system can be rolled from one surgery room to another if desired. When ready for use, it
can be rolled out to the surgery couch and treatment given, then rolled back and the
surgical closure done. This reduces time and trauma when contrasted to the current
practice of transporting the patient from surgery to a shielded radiation room, treating and
then returning the patient to surgery for closure. The systems now installed are being
used for a variety of treatments (Figure 6). The following is a list of some of the
modalities employed.
• Biliary
hColorectral
h Bladder
hEsophageal
• Bone
hExtremity
hBrain
hSarcomas
• Breast
hHepatic
hCervical
hLung
The unique elements of this design are the mobility of a system (Figure 7), which with
some design changes from the prototype operates at energies of 4, 6, 9 and 12 MeV. The
energy is push button selectable. The output dose rate can be selected at 2.5 or 10
Gy/min. Measurements of radiation shielding for the mobile source have been done; the
detailed results are available in reference 2 and 3.
Future Developments: There are two major areas under development and in the
prototype stage. The first is to increase dose rate on the Accuray system from the present
level of 3.0 Gy/min. maximum to at least 4.0 Gy/min. The intent is to further increase
dose rate by improving the electron beam trajectories in the accelerator. The second
major development is to produce a lighter, smaller pulse system to make the footprint
much less and reduce the overall weight(Figure 8). With the intraoperative unit the
resultant size of the cabinet housing the modulator will be reduced by about 50% and the
weight will be reduced by 35%. The pulse system is switched using a solid state
modulator and at average power levels employed with the Intraop system, a single phase,
220V power source is suitable. This makes transportability and power access very
straightforward.
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Russell G. Schonberg: The History of the Portable Linear Accelerator
References:
1) Adler, J.R., M.D., Murphy, M.J., Ph.D., Chang, S.D., M.D., Hancock, S.L., M.D.,
Image-guided Robotic Radiosurgery, Dept. of Neurosurgery (JRA, SDC) and Radiation
Oncology (JRA, MJM, SLH), Stanford University Medical Center, Stanford, California,
1999.
2) Davis, J.L., M.S.< Mills, M.D., Ph.D., Shielding assessment of a mobile electron
accelerator for intraoperative radiotherapy, Dept. of Radiation Oncology, University of
Louisville, Louisville, KY, 2001.
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Russell G. Schonberg: The History of the Portable Linear Accelerator
Figure 1: Portable Linear Accelerator System
Figure 3: System Installed
Figure 2: Cyberknife System
Figure 4: Treatment Beam Angle
Figure 3: System Configuration
Figure 5: Mobetron System
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Russell G. Schonberg: The History of the Portable Linear Accelerator
Figure 6: Portable Intraoperative Therapy
Figure 7: Mobetron in Transit
Figure 8: Mobetron in Surgery
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Russell G. Schonberg: The History of the Portable Linear Accelerator
References - Scientific Articles and Book Chapters
Adler, J.R., Murphy, M.J., Chang, S.D., Hancock, S.L.: Image-guided Stereotactic Radiosurgery.
Neurosurgery 44(6):1299-1307, 1999.
Adler, J.R., Schweikard, A., Murphy, M., Hancock, S.: Image-guided Stereotactic Radiosurgery: The
Cyberknife. In, Barnett, G., Roberts, D., Maciunas, R. (ed.): Image-Guided Neurosurgery: Clinical
Applications of Interactive Surgical Navigation, Quality Medical Publishing, Inc., 16:193-204, 1988.
Adler, J.R., Chang, S.D., Murphy, M.J., Doty, J.R., Geis, P., Hancock, S.L.: The Cyberknife: A frameless
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Adler, J.R., Cox, R.S.: Preliminary clinical experience with the Cyberknife: Image-guided Stereotactic
Radiosurgery. In, Alexander III, E., Kondziolka, D. and Loeffler, J.S. (eds): Radiosurgery, S. Karger,
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Adler, J.R., Schweikard, A., Tombropoulos, R. Latombe, J.C.: Modeling and planning for sensor based
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Adler, J.R., Hancock, S.L.: The Neurotron 1000: A system for frameless stereotactic radiosurgery. In M.
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Adler, J.R.: Image-based frameless stereotactic radiosurgery. In, R.J. Maciunas (ed): Interactive ImageGuided Neurosurgery, American Association of Neurological Surgeons Publication Committee, Park
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Chang, S.D., Adler, J.R.: Current status and optimal use of radiosurgery. Oncology 15(2):209-221, 2001.
Chang, S.D., Murphy, M.J., Martin, D.P., Adler, J.R.: Frameless Stereotactic Radiosurgery. In, Petrovich,
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Chang, S.D., Adler, J.R.: Current status and optimal use of radiosurgery. Oncology 15(2):209-221, 2001.
Chang, S.D., Murphy, M.J., Martin, D.P., Adler, J.R.: Frameless Stereotactic Radiosurgery. In, Petrovich,
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Change, S.D., Martin, D.P., Adler, J.R.: Stereotactic Radiosurgery with the Cyberknife. In, M. Schulder
(ed): The Handbook of Stereotactic and Functional Neurosurgery, Marcel Dekker, New York, 2000.
Chang, S.D., Murphy, M.J., Martin, D.P., Hancock, S.L., Doty, J.R., Adler, J.R.: Image-guided robotic
radiosurgery: Clinical and radiographic results with the Cyberknife. In, Alexander III, E., Kondziolka, D.,
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Chang, S.D., Murphy, M.J., Doty, J.R., Adler, J.R.: Stereotactic radiosurgery with the Cyberknife. In, M.
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Change, S.D., Murphy, M.J., Doty, J.R., Adler, J.R.: Stereotactic radiosurgery: New innovations. In, Fisher
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Change, S.D., Tate, D.J., Goffinet, D.R., Martin, D.P., Adler, J.R.: Treatment of Nasopharyngeal
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Functional Neurosurgery 73(1-4):64-67, 1999.
Chang, S.D., Murphy, M.J., Geis, P., Martin, D.P., Hancock, S.L., Doty, J.R., Adler, J.R.: Clinical
experience with image-guided robotic radiosurgery (The Cyberknife) in the treatment of brain an dspinal
cord tumors. Neurologia Medico-Chirurgica 38 (11):780-783, 1998.
Chang, S.D., Martin, D.P., Adler, J.R>: Treatment of spinal AVMs and vascular tumors with frameless
imaged-based radiosurgery. Journal of Neurosurgery 88 (1):201A, 1998.
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Maciunas, R.J. (eds): Advanced Neurosurgical Navigation, Thieme Medical and Scientific Publishers, Inc.,
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Chenery, S.G.: Unique radiation safety aspects of a robotic linac for stereotactic radiosurgery. Health
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Russell G. Schonberg: The History of the Portable Linear Accelerator
Chenery, S.G., Massoudi, F., De Salles, A.A.F., Davis, D.M., Chehabi, H.H., Adler, J.R.: Clinical
experience with the Cyberknife at Newport Radiosurgery Center. In, Alexander III, E., Kondziolka, D.,
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Basel, Switzerland, 3:34-40, 2000.
Chenery, S.G., Chehai, H.H., Davis, D.M., Adler, J.R.: The Cyberknife: Beta system descriptionand initial
clinical results. Journal of Radiosurgery 1(4):241-249, 1998.
Fuller, B.G., Kaplan, I.D., Adler, J.R., Cox, R.S., Bagshaw, M.A.: Stereotaxic radiosurgery for brain
metastases: The importance of adjuvant whole brain irradiation. International Journal of Radiation
Oncology Biology Physics 23 (2):413-418, 1992.
Guthrie, B.L., Adler, J.R.: Computer-assisted preoperative planning, interactive surgery, and frameless
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Guthrie, B.L., Adler, J.R.: Frameless stereotaxy. Perspectives in Neurological Surgery 2 (1):1-22, 1991.
Murphy, M.J., Adler, J.R., Bodduluri, M., Dooley, J., Forster K., Hai, J., Le, Q., Luxton, G., Martin, D.P.,
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Murphy, M.J.: The importance of computed tomography slice thickness in radiographic patient positioning
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frameless sterotaxic radiosurgery. Medical Physics 24(6):857-866, 1997.
Murphy, M.J., Cos, R.S.: The accuracy of dose localization for an image-guided frameless radiosurgery
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Ryu, S.I., Kim, D.H., Murphy, M.J., Le, Q., Martin, D.P., Chang, S.D.: Image-guided frameless robotic
stereotactic radiosurgery to spinal lesions. Neurosurgery, In press, 2001.
Schweikard, A., Glosser, G., Bodduluri, M., Murphy, M.J., Adler, J.R.: Robotic motion compensation for
respiratory movement during radiosurgery. Computer Aided Surgery 5(4):263-77, 2000.
Schweikard, A., Bodduluri, M., Adler, J.R.: Planning for camera-guided robotic radiosurgery. IEEE
Transactions on Robotics and Automation 14(6):951-962, 1998.
Schweikard, A., Adler, J.R.: Robotic radiosurgery with non-cylindrical collimators. Computer Aided
Surgery 2:124-134, 1997.
Schweikard, A., Adler, J.R., Latombe, J.C.: Motion planning in stereotaxic radiosurgery. In, Taylor, R.H.,
Lavellee, S., Burdea, G.C., Mosges R. (eds): Computer-Integrated Surgery, Technology and Clinical
Applications, MIT Press, Cambridge, MA, 1995.
Schweikard, A., Tombropoulos, R., Kavraki, L, Adler, J.R., Latombe, J.C.: Treatment planning for a
radiosurgical system with general kinematics. Proceedings of the IEEE International Conference on
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Schweikard, A., Adler, J.R., Latombe, J.C.: Motion planning in stereotaxic radiosurgery. IEEE
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Shiomi, H., Inoue, T., Nakamura, S., Inoue, T.: Quality assurance for an image-guided frameless
radiosurgery system using radiochromic film. Radiation Medicine 18(2):107-13, 2000.
Tate, D.J., Adler, J.R., Chang, S.D., Marquez, S., Eulau, S.M., Fee, W.E., Pinto, H., Goffinet, D.R.:
Stereotaxic radiosurgical boost following radiotherapy in primary nasopharyngeal carcinoma: Impact on
local control. International Journal of Radiation Oncology, Biology and Physics, 45(4):915-921, 1999.
Tombropoulos, R., Adler, J.R., Latombe, J.C.: Carbeamer: A treatment planner for a robotic radiosurgical
system with general kinematics. Journal of Medical Image Analysis 3(3):237-264, 1999.
Tombropoulos, R., Latombe, J.C., Adler, J.R.: Inverse treatment planning for the Cyberknife. In,
Kondziolka, D. (ed): Radiosurgery 1997, S. Karger, Basel, Switzerland, 2:236-250, 1997.
Internet
Adler, John R. and Steven D. Chang. Radiosurgery using the Cyberknife technology. L.D. Lunsford (ed),
Stereotactic Radiosurgery, YourDoctor.com.
IORT for Breast Cancer
IORT for Breast Cancer – Current Clinical Oncology – Battle, DuBois, Merrick, & Dobelbower – pages
521 – 526
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Russell G. Schonberg: The History of the Portable Linear Accelerator
IORT for Early Breast Cancer: A Report on Long Term Results – Clinical Applications and Results of
IORT: Breast, Pleura, Soft Tissues, Bone and Lung, Merrick, Battle, Padgett, Dobelbower, Jr.- pages 126130
Intra-Operative Radiation Therapy in Breast Carcinomas – Dept of Radiotherapy CRLC Val d’Aurelle
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IORT’s return – October Issue – Advance for Administrators in Radiology & Radiation Oncology –
Dobelbower – pages 1-2
Colerectal Primary
Primary Colerectal EBRT and IOERT – Current Clinical Oncology- Willett, Shellito, Gunderson –
pages 249-272
Locally Advanced Primary Colorectal Cancer: Interoperative Electron and External Beam
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Nelson, Martenson, Cha, Haddock, Devine, Fieck, Wolfe, Dozois and O’Connell – pages 601-612
Feasibility and First Results of Multimodality Treatment, Combining EBRT,
Extensive Surgery, and IOERT in Locally Advanced Primary Rectal Cancer
Clinical Investigation – PII-S0360-3016(99)00492-7- Mannaerts, Martin, Crommelin, Dries, Repelaer van
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Colorectal Recurrent
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Russell G. Schonberg: The History of the Portable Linear Accelerator
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Gastric IORT
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Genitourinary IORT
Genitourinary IORT, - Current Clinical Oncology: Intraoperative Irradiation:
Techniques and Results, - Calvo, Zincke, Gunderson, Aristu, Gerard and Berian, - pages
421-436.
IORT for Locally Advanced or Recurrent renal cell Carcinoma, Departments of
Radiotherapy and Urology, University of Heidelberg, Germany, Eble, Stahler,
wannenmacher, - pages 253-255.
Pilot Study of IORT for Bladder Carcinoma, - Departments of Radiatin therapy,
Epidemiology and Surgery, Centre Hospitalier, Department of Urology, Hospital
Edouard-Herriot, Department of Urology, Hospital St Joseph-St Luc, Lyon France, Gerard, Hulewicz, Marechal, Dubernard, Ayzue, Gilly, Sentenac, Coquard, - pages 250252.
Intraoperative and External Preoperative Radiotherapy in Invasive Bladder Cancer
Effect of Neoadjuvant Chemotherapy in Tumor Downstaging, - Clinica
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Russell G. Schonberg: The History of the Portable Linear Accelerator
Universitaria, School of medicine University of Navarra, Pamplona, Spain, - Calv,
Aristu, Abuchaibe, Rebollo, Hidalgo, Zudaire, Berian, Azinovic, - pages 61-66.
Gynecologic IORT
Locally Advance Primary and Recurrent Gynecologic Malignancies, - Current
Clinical Oncology: Intraoperative Irradiation: Techniques and Results, - Haddock,
Martinez-Monge, Petersen, Wilson, - pages 397-419.
Interoperative Radiation Therapy in the Treatment of pelvic Gynecologic
Malignancies: a Review of Fifteen Cases, Massachusetts General Hospital, Boston,
Massachusetts, - del Carmen, McIntyre, Fuller, Nikrui, Goodman, pages 457-462.
Intraoperative Radiotherapy for Locally Advance Gynecological Malignancies,
Mayo Clinic, Rochester, Minn., Haddock, Petersen, Webb, Wilson, Podratz, Gunderson,
pages 1-5.
Intraoperative Radiation Therapy in Gynecologic Cancer: Update of the
Experience at a Single Institution, Mayo Clinic, Rochester, Minn, - Garton, Gunderson,
Webb, Wilson, Cha, Podratz, - pages 839-843.
The role of IORT as salvage Therapy for Recurrent cervical and Endometrial
Carcinoma, - Centre Hospitalier, Lyon, France, Gerard, Collin, ayzac, Dargent,
Raudrant, Gilly, Romestaing, Sentencac, Coquard, - pages 1-5.
The Use of Intraoperative Radiation Therapy in Radical Salvage for Recurrent
Cervical Cancer: Outcome and Toxicity, - University of Washington Medical Center,
Seattle, Wash, - Stelzer, Koh, Greer, Cain, Tamimi, Figge. Goff, Griffin, - pages 1881 –
1888.
Intraoperative Radiation Therapy in Recurrent Carcinoma of the Uterine Cervix,
report of the French Intraoperative Group on 70 Patients, - Centre Rene
Gauducheau, Nantes, Grance, Hospices civils de Lyon, France, Centre val d’Aurelle,
Montpelier, France, Centre Francois Bacless, Caen France, Foundation Bergonie,
Bordeaux, France, Centre Claudias Regaud, Toulouse, France, Centre alexi Vautrin,
Nancy , France, Hopital Bellevue, Saint-Etienne, France.- Mahe, Gerard, Dubois,
roussel, Bussieres, Delannes, Guillemin, Schmitt, Dargent, Guillard, Martel, Richaud,
Cuilliere, Ranieri, Malissard, - pages 21-26.
IORT for Head and Neck
IORT for Head and Neck Cancer, Current Clinical Oncolgy, Intraoperative
Irradiation: Techniques and Results, - Foote, Garrett, Rate, Nag, Martinez-Monge,
Schmitt, McCaffrey, - pages 471-497.
Adjuvant Electron Beam Intraoperative Radoiptherapy (EB-IORT) in High Risk
Head and Neck Cancer Patients, - Department of Oncology and Otolaryngology,
University of Californai/Mt. Zion Cancer Center, San Francisco, CA , - Coleman, Roach,
Ling, Kroll, Kaplan, Chan, Fu, Singer, - pages 1-10.
IORT Following Neck Dissection,- Seaward, pp.1-4.
IORT in the Management of Locally Advance or Recurent Head and Neck Cancer, Department of Oncology, Clinica Universitaria de Navarra, Pamplona, Spain, Martinez-Monge, Azinovic, Alcalde, Aristu, Paloma, Garcia-Tapia, Calvo, - pages 122125.
Management of the N3 Neck: Intraoperative Radiation, - Head and Neck Cancer, Hamaker, Singer, Pugh, Ross, Garrett, pp. 163-166.
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Russell G. Schonberg: The History of the Portable Linear Accelerator
Intraoperative Radiation Therapy (IORT) for Locally Advanced Oropharyngeal
Carcinomas with Major Extension to the Base of the Tongue, - Saint – Etienne,
France, - Schmitt, Prades, Favrel, Mayaud, Puel, Barbet, Pinto Calloc’h, TrombertPaviot, Martin, pages 1-5.
Intraoperative Radiation Therapy for Advanced or recurrent Head and Neck
Cancer, - Department of Radiation Therapy, Methodist Hospital of Indiana,
Indianapolis, Indiana, - Garrett, Pugh, Ross, Hamaker, Singer, - pages 783-786.
Hepatobiliary IORT
Biliary Tract IORT, - Current clinical Oncology: Intraoperative Irradiation:
Techniques and Results, Todoroki, Gunderson, Nagorney, - pages 223-247.
Interoperative Radiation Therapy in Resected Bile Duct Cancer, - Department of
Radiation Oncology, Massachusetts General Hospital, Boston, MA, - Willett, pages 523524.
Benefits of Adjuvant Radiotherapy After Radical Resection of Locally Advanced
Main Hepatic Duct Carcinoma, - Departments of Surgery and Radiology, Institute of
Clinical Medicine, University of Tsukuba, Tsukuba-shi, Japan, - todoroki, Ohara,
Kawamoto, Koike, Yoshida, Kashiwagi, Otsuka, Fukao, - pages 581-587.
Intraoperative Radiotherapy for Resectable Extrahepatic Bile Duct Cancer,
Departments of Radiation Therapy and Surgery, Tokyo Metropolitan Komagome
Hospital, Tokyo, Japan, - Kurosaki, Karasawa, Kaizu, Matsuda, Okamoto, Sato, Ebara,
Tanaka, - pages 635-638.
IORT of Carcinoma of the Extrahepatic Bile Ducts, Department of Radiotherapy and
General Surgery, Universitatsklinikum Essen, Germany, Willborn, Sauerwein, Erhard,
Hulternschmidt, Ghilescu, Eigler, Sack, pages 173-176.
IORT Combined with Resection for Stage IV Gallbladder Carcinoma, Departments
of Surgery and Radiology Institute of clinical Medicine, University of Tsukuba, Japan, Todoroki, Kawamoto, Otsuka, Takada, Adachi, Yuzawa, Koike, Yoshida, Fukao, Ohara,
- pages 165-172.
IORT for Lung and Esophagus
Lung Cancer – EBRT withor without IORT, - Current clinical Oncology;
Intraoperative Irradiation: Techniques and Results, - Aristu, Calvo, Martinez, Dubois,
Santos, Fisher, Azinovic, - pages 437-453.
Cisplatin, Mitomycin, and Vindesine followed by Intraoperative and Postoperative
Radiotherapy for Stage III Non-Small Lung cancer: Final Results of a Phase II
study, - Departments of Radiation Oncology, Medical Oncology, Clinica Universitaria
de Navarra, University of Navarra, Pamplona, Spain, - Aristu, Rebollo, MartinewzMonge, Aramendia, Viera, Azinovic, Herreros, Brugarolas, pages 276-281.
Interoperative Radiation Therapy combined with External Irradiation in
Nonresectable Non-small-cell Lung Cancer: Preliminary Report, - Department of
Thoracic and Hyperbaric Surgery, University Medical School of Graz, Austria, Juettner, Arian-Schad, Porsch, Leitner, Smolle, Ebner, Hackl, Friehs, - pages 1143-1149.
Combined Treatment in Superior Sulcus Tumors, - Department of Oncology, Clinica
Universitaria de Navarra, Universidad de Navarra, Spain, - Martinez-Monge, Herreros,
Aristu, Aramendia, Azinovic, - pages 317-322.
Intraoperative Radiotherapy during Lung Cancer Surgery: Technical Description
and Early clinical Results, - Clinica Universitaria de Navara, School of Medicine,
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Russell G. Schonberg: The History of the Portable Linear Accelerator
University of Navarra, Pamplona, Spain, - Calvo, de Urina, Abuchaibe, Azinovic, Aristu,
Santos, Escude, Herreros, Llorens, - pages 103-109.
IORT for Non-Small-Cell Lung Cancer: Preliminary Report of 33 Cases, Department of Radiotherapy, General Hospital of PLA, Beijing, P.R. China, - Zeng,
Chang, Sun, - pages 138-139.
Comparison Between Chemoradiation Protocol Intendeded for Organ Preservation
and Conventional Surgery for clinical T1-T2 Esophageal Carcinoma, - Departments
of Radiology, Gastroenterology and Abdominal Surgery, Tenri Hospital, Tenri City, Nara
Prefecture, Japan, - Murakami, Kuroda, Nakajima, Okamoto, Mizowaki, Kusumi,
Hajiro, Nishimura, Matsusue, Takeda, - pages 277-284.
Intraoperative Radiation Therapy to the Upper Mediastinum and Nerve-Sparing
Three-Field Lymphadenectomy Followed by External beam Radiotherapy for
Patients with Thoracic Esophageal Carcinoma, - Keiyu-kai Sapporo Hospital,
Hokkaido University School of Medicine, Sapporo, Japan, - Hosokawa, Shirato, Ohara,
Kagei, Hashimoto, Nishino, Takamura, Arimoto, - pages 6-13.
Pancreas IORT
IORT in Pancreatic Carcinoma, - Current Clinical Oncology: Introperative
Irradiation: Techniques and Results, - Termuhlen, Evans, Willett, - pages 201-222.
Palliative Operation for Cancer of the Head of the Pancreas: Significance of
Pancreaticoduodenectomy and Intraoperative Radiation Therapy for Survival and
Quality of Life, - Department of Surgery, Miyagi cancer Center Hospital, Natori, Japan,
- Ouchi, Sugawara, Ono, Fujiya, Kamiyama, Kakugawa, Mikuni, Yamanami, - pages
413-417.
Intraoperative Radiotherapy for Pancreatic Carcinoma with Hepatic or Peritoneal
Metastases, - Department of Surgery II, Department of Radiology, Nagoya University
School of Medicine, Nagoya, Japan, - Nakao, Harada, Nonami, Kaneko, Takeda,
Kurokawa, Ishigaki, Takagi, - pages 1469-1471.
Intraoperative radiotherapy in resected pancreatic cancer: feasibility and results, Hospices Civils de Lyon, Lyon, France, - Coquard, Ayzac, Gilly, Romestaing, Ardiet,
Sondaz, Sotton, Sentenac, Braillon, Gerard, - pages 271-275.
Preoperative, Chemoradiation, pancreaticoduodenectomy, and Intraoperative
Radiation Therapy for Adenocarcinoma of Pancreatic Head, - Departments of
surgical Oncology, pathology, Gastrointestinal Medical Oncology and Digestive diseases
and Radiation Oncology, University of Texas, Houston, Texas, - Staley, Lee, Cleary,
Abruzzese, Fenoglio, Rich, Evans, - pages 118-125.
Intraoperative radiotherapy for resectable and unresectable pancreatic carcinoma, Nagoya University School of Medicine, Nagoya, Aichi, Japan, - Nakao, Harada, Nonami,
Kaneko, Inoue, Takagi, - pages 252-256.
Analysis of the Clinical Benefit of Intraoperative Radiotherapy in Patients Undergoing
macroscopically curative resection for Pancreatic Cancer – Department of Therapeutic Radiology and
Oncology, Kyoto University – Kokubo, Yasumasa, Nishimura, Shibamoto, Sasai, Kanamori, Hosotani,
Imamura, Hiraoka – pages 1081-1087.
Pediatric IORT
Pediatric Malignancies, - Current Clinical Oncology: Introperative Irradiation: Techniques and Results,Schomberg, Merchant, Gerald, Haase, Aristu, - pp455-470.
Intraoperative Radiation Therapy for High-Risk Pediatric Neuroblastoma, - Departmentsof Radiation
Oncology, Surgery, pediatrics, andBiostatistics, University of California, San Francisco, CA., - HaasKogan, Fisch, Wara, Swift, Farmer, Harrison, Albanese, Weinberg, Matthay, - pp. 985-992.
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Russell G. Schonberg: The History of the Portable Linear Accelerator
Preliminary Results of Phase I/II Study of High-Dose-Rate Intraoperative Radiation Therapy for
Pediatric Tumors, - Brachytherapy Service Department of Radiation Oncology, Memorial Sloan Kettering
Cancer Center, New York, NY,- Zelefsky, LaQuaglia, Ghavimi, Bass, Harrison, - pp. 267-262.
Intraoperative Radiotherapy in the Multidisciplinary Treatment of Bone Sarcomas in Children and
Adolescents, - Medical and Pediatric Oncology, - Calvo, Ortiz de Urbina, Sierrasesumage, Abuchaibe,
Azinovic, Antillon, Santos, Canadell, - pp478-485.
Intraoperative Radiotherapy in the Treatment of Neuroblastoma: Report of a Pilot Study, Departments of Surgery and Pediatric Surgery, Loma Linda Medical Center, Loma Linda, CA, - Aien,
Hopkins, Archambeau, Moores, Weeks, Bedros, Andres, Smith, - pp. 343-350.
Intraoperative Radiotherapy in the Multidisciplinary Treatment of Pediatric Tumors, - Department
of Oncology, Pediatric Oncology Unit, Surgery, and Orthopedic Surgery, Clinica Universitaria,
Universidad De Navarra, Pamplona, Spain, - Calvo, Sierrasesumaga, Santos, Voltas, Beian, Canadell, - pp.
257-260.
Retroperitoneal Sarcomas
Electron or Orthovoltage IORT for Retroperitoneal Sarcomas, - Current Clinical Oncology:
Intraoperative Irradiation: Techniques and Results, - Gieschen, Willett, Donohue, Petersen, Spiro, Calvo,
Gunderson, - pages 329-349.
Intraoperative Electron Beam Radiation Therapy for Retroperitoneal Soft Tissue Sarcoma, Departments of Radiatin Medicine, Orthpedics and Pathology, Mass. General Hospital, Harvard medical
School, Boston, Massachusetts, - Willett, Suit, Tepper, Mankin, Convery, Rosenberg, Wood, - pages 278283.
Extremity and Trunk Soft Tissue Sarcomas
Extremity and Trunk Soft Tissue Sarcomas – EBRT With or Without IORT, - Current Clinical
Oncology: Intraoperative Irradiation: Techniques and Results, - Petersen, Calvo, Gunderson, Pritchard,
Azinovic, Haddock, Eble, - pages 359-378.
IORT for Bone Sarcomas, - Current Clinical Oncology: Intraoperative Irradiation: Techniques and
Results, - Calvo, Sierrasesumaga, Willich, Amillo, Canadell, - pages 379-395.
Intraoperative radiotherapy for primary and locally recurrent soft tissue sarcoma: Morbidity and
long-term prognosis, - University of Heidelberg, Heidelberg, Germany, - Lehnert, Schwarzbach, Willeke,
Treiberg, Hinz, Wannenmacher and Herfarth, - pages s21-s24.
Sciatic Nerve Resection in the Thigh, - Mayo Clinic, Rochester, MINN, - Fuchs, Davis, Wunder, Bell,
Masri, Isler, Turcotte, Rock, - pages 34-41.
IORT Summaries
IORT – Current and Future Status - 2000
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