AUTHOR=Calvo Felipe A. , Ayestaran Adriana , Serrano Javier , Cambeiro Mauricio , Palma Jacobo , Meiriño Rosa , Morcillo Miguel A. , Lapuente Fernando , Chiva Luis , Aguilar Borja , Azcona Diego , Pedrero Diego , Pascau Javier , Delgado José Miguel , Aristu Javier , Alonso Alberto , Prezado Yolanda 

TITLE=Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1037262

DOI=10.3389/fonc.2022.1037262

ISSN=2234-943X

ABSTRACT=Background: Oligo-recurrent disease has a consolidated evidence of long-term surviving patients thanks to the use of intense local cancer therapy. The latter combines real-time surgical exploration/resection with high energy electron beam single dose of irradiation. This results in   a very precise radiation dose deposit, which is an essential element of contemporary multidisciplinary individualized oncology. 
Methods: Patients candidates to proton therapy were evaluated in Multidisciplinary Tumor Board to consider improved treatment options based upon the institutional resources and expertise. Proton therapy was delivered by means of a synchrotron- based pencil beam scanning technology.
Results: In a period of 24 months 327 patients were treated with proton therapy: 218 were adults, 97 had recurrent cancer and 54 required re-irradiation. In 5 cases the integral strategy to optimize the local disease management was the combination of surgery, intraoperative electron boost components of the radiotherapy treatment and external pencil beam proton therapy.
Conclusions: Individual case-solutions strategies combining intraoperative electron radiation therapy and proton therapy for oligo-recurrent or unresectable localized cancer patients are feasible. The potential of this combination can be clinically explored with electron and proton FLASH beams