Morcillo, M.A. (Miguel Ángel)

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    Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development
    (Springer, 2022) Asencio, J.M. (José Manuel); García-Sabrido, J.L. (José Luis); Aristu-Mendioroz, J.J. (José Javier); Miñana-López, B. (Bernardino); Palma, J. (Jacobo); Lapuente, F. (Fernando); Cuesta, M.A. (Miguel Ángel); Pascau, J. (Javier); Cambeiro, M. (Mauricio); Morcillo, M.A. (Miguel Ángel); Valle, E. (Emilio) del; Serrano-Andreu, J. (Javier); Calvo-Manuel, F.Á. (Felipe Ángel); Solé, C. (Claudio)
    Background Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and efective local therapeutic approach. Integrating the benefts from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efcient combined modality therapy. Methods Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. Results In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no diferences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging efects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. Conclusions Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and ofers a new model explored with electron-FLASH beams.
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    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
    (Frontiers, 2022) Aguilar, B. (Borja); Pedrero, D. (Diego); Aristu-Mendioroz, J.J. (José Javier); Ayestaran, A. (Adriana); Alonso, A. (Alberto); Meiriño, R. (Rosa); Palma, J. (Jacobo); Calvo, F.A. (Felipe A.); Lapuente, F. (Fernando); Chiva, L. (Luis); Pascau, J. (Javier); Cambeiro, M. (Mauricio); Morcillo, M.A. (Miguel Ángel); Prezado, Y. (Yolanda); Serrano-Andreu, J. (Javier); Delgado, J.M. (José Miguel); Azcona-Armendariz, J.D. (Juan Diego)
    Background: Oligo-recurrent disease has a consolidated evidence of long-term surviving patients due 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: Patient candidates to proton therapy were evaluated in Multidisciplinary Tumor Board to consider improved treatment options based on the institutional resources and expertise. Proton therapy was delivered by a synchrotron-based pencil beam scanning technology with energy levels from 70.2 to 228.7 MeV, whereas intraoperative electrons were generated in a miniaturized linear accelerator with dose rates ranging from 22 to 36 Gy/min (at Dmax) and energies from 6 to 12 MeV. 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. The specific radiation modalities selected in five cases included an integral strategy to optimize the local disease management by the combination of surgery, intraoperative electron boost, and external pencil beam proton therapy as components of the radiotherapy management. Recurrent cancer was present in four cases (cervix, sarcoma, melanoma, and rectum), and one patient had a primary unresectable locally advanced pancreatic adenocarcinoma. In re-irradiated patients (cervix and rectum), a tentative radical total dose was achieved by integrating beams of electrons (ranging from 10- to 20-Gy single dose) and protons (30 to 54-Gy Relative Biological Effectiveness (RBE), in 10–25 fractions). Conclusions: Individual case solution strategies combining intraoperative electron radiation therapy and proton therapy for patients with oligo-recurrent or unresectable localized cancer are feasible. The potential of this combination can be clinically explored with electron and proton FLASH beams.