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IORT
A safe, effective choice

Intra-Operative Radiation Therapy (IORT) is a treatment which allows radiation to be applied to the tissue around the tumour in the operating room itself. It is now a consolidated, well known technique, its efficacy proven by a large number of clinical studies.
The patient is treated immediately after tumourectomy with a single dose of a few dozen Grays of radiation while still anaesthetised. The emission duration depends on the technology used: from a maximum of 30-40 minutes for technologies with lower penetration levels down to a minimum of 1 minute for methods that use electrons.


Beyond IORT, Intra-Operative Electron Radiation Therapy (IOERT).

Electron IORT (IOERT) is the most complete, effective, fast intra-operative radiation therapy method. Technological developments have allowed the use of miniaturised mobile linear accelerators which are lightweight and easy to handle, allowing patients to be treated quickly, without moving them off the operating table. Used as an alternative and/or addition to conventional external radiation therapy, this technique has obvious clinical, operational, social and economic benefits:

  • MORE EFFECTIVE TREATMENT
  • SHORTER TREATMENT TIMES
  • VERY FEW OR NO THERAPY SESSIONS
  • LESS RADIATION ABSORBED BY PATIENT
  • FEWER COMPLICATIONS FROM RADIATION SIDE-EFFECTS

Clinical Benefits

The aim when irradiating a tumour is to direct the highest possible dose at the tumour itself while complying with the tolerance limit for the surrounding healthy tissue.
Intra-operative radiation therapy allows:
- irradiation of the tumour bed with a direct view of the cavity
- sparing of the tumour-free structures or particularly sensitive, vulnerable structures
- administration of higher therapy doses
- administration of extremely uniform doses

Since there is no time gap between surgery and radiation therapy, the cancer cells have no opportunity to reproduce, with a sharp reduction in local recurrences.

“Click HERE for the latest update on case statistics, new protocols and new procedures for use for IORT therapy for each category of disease”

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The radiobiological effect of a single administration of high-dose IOERT is considered about 1.5-2.5 times greater than that of the same dose fractionated. For example, a dose of 21Gy is equivalent to fractionated therapy of about 52 Gy: this offers the scope for significantly reducing the dose administered to the patient, with a decrease in radiation-derived complications.

The data in the literature and those which emerged from the world congress of the International Society of Intra-Operative Radiotherapy (ISIORT) in Madrid on 10-13 June 2008 recommend the use of IORT for the following diseases:

  • BREAST CANCERS
  • LOCALLY ADVANCED RECTAL CANCERS
  • PROSTATE CANCERS
  • PELVIC RECURRENCES
  • PANCREATIC CANCERS
  • GASTRIC CANCERS
  • SOFT TISSUE SARCOMAS 

For other types of cancers, such as gynaecological, lung and oesophagus cancers, the data show a clear reduction in local recurrences and an improvement in any symptoms.

Social Benefits

The social and economic benefits of removing the need for patients to travel to the centre for subsequent external radiation therapy sessions are clear at once. There is a drastic reduction in all the usual sources of distress and inconvenience: the anxiety of patients waiting, often for months, for their first radiation therapy session; travel problems for patients and family members; and the stress generated by lengthy radiation therapy sessions in uncomfortable settings. There are many major benefits, not least in terms of quality of life.

Operational Benefits

One example of this principle’s application in clinical practice is the conservative treatment of breast cancer in post-menopausal patients, who receive a single administration of IORT of 21 Gy lasting about one minute after removal of the tumour.
Just one minute of IOERT has replaced 5 weeks of external beam radiation therapy, previously necessary for post-operative patients. “Single dose” therapy is certainly a ground-breaking development, but the capability for reaching very high total doses of radiation therapy by using IOERT as a boost is equally important.

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For some types of patient, doses of external radiation therapy in excess of 60 Gy, in fractionated doses of 1.8-2 Gy/day, would be necessary to control their disease. However, this dose is unthinkable: it is well known that doses over 45-50 Gy cannot be administered because of the toxic effects on the healthy organs through which the X-ray beams pass.

If intra-operative electron radiation therapy (IOERT) is used in association with external beam radiation therapy (EBRT) and an IOERT treatment is combined with a fractionated external radiation therapy dose of 45-50 Gy,  the actual dose administered rises to 60-80 Gy with an IOERT of 10 Gy, or 85-100 Gy with a 20 Gy IOERT session.

From the example of breast cancer alone, the multiple problems solved by a single IORT session are immediately clear: the reduction of waiting lists for treatment with conventional accelerators not only allows work to be organised more effectively but has major implications for a radiation therapy department’s performance and efficiency.

For the vast majority of oncological radiation therapy centres, it can soon be calculated that if the breast cancers treated with IOERT alone were removed from the external beam radiation therapy workload, waiting times for the other types of tumour requiring radiation therapy treatment would be reduced within the limits required by the protocols.

Moreover, the IORT session in the operating room lasts around 10/15 minutes and takes up much less of the radiation therapy department staff’s time compared to the standard procedures requiring the patient to be positioned in the bunker (multiplied by five in the case of the single dose therapy described above). In the operating room the patient is anaesthetised and certainly more cooperative than underneath a conventional accelerator.

Wenn die intraoperative Strahlentherapie mit Elektronen (IOERT) in Verbindung mit externen Strahlentherapie (EBRT) eingesetzt und mit einer fraktionierten externen Strahlentherapie-Dosis von 45-50 Gy kombiniert wird, dann kann die geforderte tatsächliche Gesamtdosis auf 60-80 Gy mit einem IOERT-Anteil von 10 Gy oder sogar auf 85-100 Gy mit einem 20 Gy IOERT-Anteil ansteigen.
Aus dem Beispiel allein bei “ Brustkrebs” sind vielfältige Probleme durch eine einzige IOERT Sitzung gelöst und sofort wird klar: die Reduzierung von Wartelisten für die Behandlung mit den herkömmlichen Beschleunigern erlaubt nicht nur besser organisierbare und effektivere Arbeit sondern hat erhebliche Auswirkungen auf die effizientere Leistung einer ganzen Strahlentherapie-Abteilung.
Für die überwiegende Mehrheit der onkologischen Strahlentherapie-Zentren kann schnell errechnet werden, dass die externe Strahlentherapie Arbeitsbelastung geringer wird, wenn der Anteil der Mammakarzinome allein mit IOERT behandelt, wegfällt. Zudem werden die Wartezeiten für die anderen Tumorarten, die Strahlungstherapiebehandlung erfordern ,kürzer und bleiben innerhalb der Grenzen der geforderten Protokolle..
Darüber hinaus dauert die IORT-Sitzung im OP insgesamt etwa 10-15 Minuten länger und nimmt viel weniger Zeit der Mitarbeiter von Strahlentherapie-Abteilungen in Anspruch im Vergleich zur Arbeitszeit bei den Standardverfahren, wo der Patient im Bunker erst richtig positioniert und anschließend fraktionierrt bestrahlt werden muss. (Vergl, wie oben beschrieben ) .Im Operationssaal ist der Patient betäubt und sicherlich leichter händelbar unter einem herkömmlichen Beschleuniger bei vollem Bewusstsein.

Economic Benefits

As well as the economic and social benefits and the consequent prestige, which attracts large numbers of patients, the inclusion of a IORT system in a radiation therapy department, even one with just one conventional accelerator, is certain to deliver results in terms of return on the initial investment and with regard to subsequent operation in terms of maintenance, efficiency and results.

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Apart from the fact that the purchase of a mobile LINAC costs more than 70% less on a turnkey purchase basis, the availability of single-dose IORT therapy allows the organisation to save 52% on total operating costs if operation with a conventional LINAC is compared to the electron IORT system. It should be remembered that:

  • IORT does not require thermoplastic material,
  • a IORT session takes just 10/15 minutes of Radiation Therapy staff’s time, compared to a total of 30/40 minutes for conventional Radiation Therapy,
  • only two/three Radiation Therapy staff members are required for IORT, with very little work on the part of the radiation therapist for the drawing-up of treatment plans,
  • maintenance costs are reduced by a significant percentage.

 IORT erfordert kein thermoplastisches Material ,
 eine IORT-Sitzung beansprucht nur 10-15 Minuten Zeit der Strahlentherapie-Mitarbeiter, im Vergleich zu insgesamt 30/40 Minuten für konventionelle Strahlentherapie,
 Nur zwei / drei Strahlentherapie Mitarbeiter sind für die IORT erforderlich, mit sehr wenig Arbeitsaufwand des Strahlentherapeuten, der die Behandlungspläne erstellt.
 Wartungskosten sind reduziert auf einen erheblich geringen Prozentsatz