SIT is the world leader in manufacturing dedicated miniaturized electron linear accelerators for IOeRT

“IntraOperative Radiation Therapy (IORT) in its broadest sense refers to the delivery of irradiation at the time of an operation. IORT evolved as an attempt to achieve higher effective doses of irradiation while dose-limiting structures are surgically displaced”.

“IntraOperative irradiation (IORT) refers to delivery of a single dose of irradiation to a surgically exposed tumor or tumor bed while the normal tissues are protected from the irradiation either by retracting the mobilized tissue or by shielding the anatomically fixed tissues. IORT has traditionally been performed by using an electron beam as the source of irradiation.”

With a maximum electron energy of 12 MeV, Liac is able to perform any type of IORT treatment, even those at greater depths, for cancers located on any part of the anatomy. Intra-Operative Radiation Therapy (IORT) is a treatment which allows radiation to be applied directly to the tumor bed in the operating room during surgery. It is now well-accepted technique, and its efficacy is proven by a large number of clinical studies. The patient is treated immediately following surgical removal of the tumor with either a single fraction of 21 Gy or a boost of 8 - 18 Gy. The radiation treatment is completed in less than two minutes. The total time including set up is less than 10 minutes. Single fraction patients do not require any external beam radiation therapy, while boost patients have a greatly reduced number of external beam radiation therapy sessions.

Cancers Treated with Liac HWL: ▪ Brain ▪ Breast ▪ Colorectal ▪ Esophagus ▪ Gastric ▪ Genitourinary ▪ Gynecological ▪ Head & Neck ▪ Hepatobiliary ▪ Lung ▪ Pancreas ▪ Pediatric ▪ Renal ▪ Sarcomas (Bone, Extremity, Retro-peritoneal)

ADVANTAGES OF THE IOeRT TECHNIQUE


FOR CLINICAL PRACTICE:

  • Improvement of local control; is a condition sine qua non for disease free and overall survival.
  • Reduction (in the case of boost) and elimination (in case of single dose) of the external radiotherapy cycle.
  • Time zero between surgery and the delivery of radiotherapy, neoplastic cells growth from microscopic residual disease follows an exponential course immediately after surgery. Giving IOeRT this problem is solved.
  • Precision, thanks to direct visualization of the target.
  • Significant reduction of dose to healthy tissues, the direct access of irradiation to the target allows to displace and mechanically protect numerous dose-sensitive normal tissue uninvolved by cancer.
  • Minimization of side effects, less toxicity, complete skin sparing and better cosmesis outcomes compared to external beam radiation therapy.
  • Feasibility of the treatment as the only solution when external radiation therapy is critical or even not possible (treatments of recurrences, patients with a pacemaker or decreased mobility).
  • IOeRT boost is particularly efficacious for the treatment of locally advanced cancers. IOeRT boost combined with external RT and chemotherapy allows to achieve excellent results of local control and overall survival (2016-2017 NCCN guidelines).

FOR THE PATIENT

  • Reduction of the entire cycle to a single day!
  • Elimination of side effects caused by conventional therapy.
  • Decrease in costs to undergo treatment.

FOR SOCIETY

  • Decrease of social costs associated to the need for care and lack of patient productivity.

FOR THE MEDICAL FACILITY

  • Substantial reductions in waiting lists for radiotherapy centers.

MULTI-CANCER APPLICATION

DISTRICT INDICATION Stage/Locally advanced INSTITUTION Reference RESULTS REMARKS/ IOERT effects
PANCREAS Unresectable MGH (1) 2 y 16% OS (survivors > 5y) IORT (applicator = 8cm), Charlson comorbidity index = 3 and chemotherapy improve OS
Bordeline MCR (2) 84% LC; 3 y 40% vs 0% OS Median survival: 23 m R0 vs 10 m R2/unresectable
Resectable HGUGM (3) 58% 5 y LC 98% local control with IOeRT boost
Unresectable or borderline-resectable MGH (4) 35.1 months of median OS IORT with neoadjuvant CT and CRT improve survival. No toxicity incremented by IOeRT
ESOPHAGO-GASTRIC Resectable HGUGM (5) 5 y 85% LC IOeRT significant improvement of local control
Stage II and III Meta-analysis HCMU (6) IORT improved LC Favourable effect of IORT in pts with stage II and III
GASTRIC Resectable Systematic review (7) St III IOeRT promoted OS Any stage IOeRT promoted local control
RECTAL cT2-4 N+ HGUGM (8) 5 y 96% LC Prognostic index for risk-adapted treatment.
Primary and recurrent Systematic review (9) IOeRT improved LC and OS No toxicity increment by IOeRT
Unresectable T4 MCR and CHE (10) 5 y 19.3 % LR, DFS 55%, OS 56% IOeRT and Preop CRT improve OS
Recurrent MCR and CHE (11) 5 y 45.3% local re-recurrence rate IOeRT advantage in pts with R1 and R2 resection
pT4N0/T1-4N+ Multivariate analysis (12) 5-year 89.7% LC and 69.0% DFS No increase of acute and long-term complications
PROSTATE Metastatic D1 and D2 Saitama Cancer C (13) 5-10 y 75/52% OS In D2 IORT significantly cancer-specific survival
RENAL Recurrent/Primary resected US-Europe Pooled-analysis (14) 5y 37% (p) vs 55% (r) OS Survival affected by nodal involvement, sarcomatoid features and IORT dose
PEDIATRIC Ewing/Rhabdomyosarcoma Pooled-European (15) 5-10 y 74% - 68% OS R1 and recurrent influence outcome
Neuroblastoma + sarcoma incomplete resection Heidelberg Univ (16) 1/18 local recurrences 6 clinical significant late toxicity
primary extremity soft-tissue Multicentric Pooled Analysis (17) 10-year 85% LC, 76% DFS and 81% OS IOeRT boost increased local control with low toxicity rates
SARCOMAS Retroperitoneal Heidelberg Univ (18) 5 y 72% LC Preoperative IMRT for external RT escalation
Retroperitoneal MCR (19) 5 y 89% LC 89% vs 46% S+RT vs S alone (p=0.003)
Retroperitoneal Boston Univ (20) 5 y 54% OS for liposarcoma IORT and adjuvant EBRT improved survival for liposarcoma
Resectable retroperitoneal Univ Freiburg (21) 5 y 89.5% survival rate Pts = = 55 years and R2 resection are adverse for survival
Extremity soft tissue Pooled- European (22) 5 y 82% LC In-field LC promoted by IOERT dose =12.5 Gy
Osteosarcomas Pooled-European (23) 10 y 82% LC, 73% OS R1 adverse for local control
OLIGO-RECURRENCES Gynaecologic, rectal HGUGM (24) 5 y 53% LC, 46 % OS EBRT + IOeRT compensate adverse factors fragmentation
STS, head and neck, uterine, colorectal Univ of Navarre, (25) 5 y 31% LRC, 57% DMFS, 31% OS Gross macroscopic resection is significant for LRC and radiation dose for survival