IORT

Intraoperative radiation therapy can be administered using current linear accelerator producing an electron radiation  beam.

Recently, a dedicated mobile accelerator that produce only electron energy up to 9.12 MeV has been developed. 

This device can be placed directly into the operating room without particular structural and protective requirements, thus preventing the transportation of the  patient from operating room to the bunker after the surgery has been performed.

The aim of radiotherapy is the reduction of local recurrence of the tumor by eliminating any residual malignant focus adjacent to the tumor bed.

The ability of tumor control depends on the number of tumor cells and the dose of the absorbed radiation. The partial intraoperative radiation technique  has the advantage of being conducted immediately following the cytoreduction phase, thus requiring a lower dose of radiation to obtain the biological effectiveness.

Moreover, the tissue treated during the surgery is highly vascularized and oxygenated, and this makes the therapeutic target more sensitive to the cytotoxic effects of radiotherapy.

Compared to postoperative external conventional radiotherapy, performed on the scar tissue, the IORT technique results more efficient. Intraoperative radiation therapy requires a single session, therefore it delivers a selective boost to the tumor burden.

IORT can also be used as the unique radiotherapy in early cancers of small volume, or unresectable tumors, for palliative therapy. The main technical advantage of IORT consists in the direct visualization of the target volume, and the ability to shield healthy tissues from  the radiation beam.

With IORT, potential side effects associated with conventional radiotherapy, such as irradiation of the skin, subcutaneous tissue of the lungs and heart, can be minimized.

Since small volumes are irradiated it has been reported a decreased incidence of secondary cancers induced by radiation.

Intraoperative radiotherapy is a technique for which the radiation oncologist has the full clinical responsibility (prescription and execution of treatment), but necessarily requires  a multidisciplinary approach toghether with the surgeon, the anesthesiologist, the expert in medical physics and the nursing staff.

The toxicity of IORT depends on the dose and the type of the target anatomical structure.

Complications arising from IORT are reduced, and the only side effects reported so far are the necrosis of fat tissue and a weak fibrosis, which may require surgery and transient pain. The first publications available on of 5 years follow-up trials reported a  toxicity comparable with that of conventional radiotherapy.

Intra-Operative Radiation Therapy can be administered using mobile linear accelerators producing an electron radiation beam.

Recently, a dedicated mobile accelerator that produces 9 - 12 MeV electron energy has been developed and is utilised in any operating room without the necessity for structural modifications or particular radiation protection measures, thus preventing the transportation of the patient from the operating room to the bunker after surgery.

The purpose of radiation therapy is the reduction of local recurrence of the tumor by eliminating any residual malignant foci adjacent to the tumor bed. The probability of tumor control depends on the number of tumor cells and the dose of the absorbed radiation. Intra-Operative Radiation Therapy has the advantage of being conducted in the O.R. immediately following the cytoreduction phase, thus requiring a smaller radiation dose to obtain the necessary biological effectiveness. Moreover, the tissue treated during surgery is highly vascularised and oxygenated and this makes the therapeutic target more sensitive to the cytotoxic effects of radiation therapy; if compared to postoperative external conventional radiation therapy performed on the scar tissue, the results of IORT technique are more efficient.

Intra-Operative radiation therapy can be effected in a single session (single dose) or as a boost. This allows a selective treatment on the tumor volume that can be considered effective from the therapeutic point of view in case of localized and small-volume tumors, or otherwise, integrated by partial cycles of external beam radiation therapy. IORT can also be seen as palliative therapy in case of unresectable tumors. The main technical advantage of IORT consists in the direct visualization of the target volume and the possibility to spare or shield normal surrounding tissues (OAR) from the radiation beam. With IORT, potential side effects associated with conventional radiation therapy , such as irradiation of the skin or of subcutaneous lung and heart tissue, can be minimized or totally eliminated. Since small volumes are irradiated, a decreased incidence of secondary cancers induced by radiation has been reported.

Intra-Operative Radiation Therapy is a technique where the radiation oncologist has full clinical responsibility (prescription and execution of treatment), it requires a multidisciplinary approach together with the surgeon, the anaesthesiologist, the medical physicist and the nursing staff. The toxicity of IORT is related to the dose and type of target anatomical structure, however, it is primarily a tardive effect. Complications arising from IORT are in any case reduced and the only side effects reported so far are the necrosis of fat tissue and a weak fibrosis which may require surgery and transient pain therapy.