The trend in oncological therapy is moving towards the targeted, risk-adapted and interdisciplinary treatment of tumors. INTRABEAM®, the innovative radiotherapy system from Carl Zeiss, is an ideal system for these requirements.
Targeted intraoperative radiation with INTRABEAM is a risk-adapted individualised therapy. The 30-minute irradiation procedure is performed during the operation immediately after the tumor is excised. During this procedure, the isotropic dose distribution is applied directly into the tumor cavity using a spherical applicator in a way that ensures direct contact with the target tissue. Radiation is applied precisely to the area with the highest risk of tumor recurrence. The surrounding healthy tissue is spared.
For many cancer patients who develop spinal metastases in the natural course of their disease, percutaneous kyphoplasty and vertebroplasty are a valuable treatment option. By using intraoperative radiotherapy with INTRABEAM during kyphoplasty or vertrebroplasty, the metastasis can be sterilized and if necessary vertebra simultaneously stabilized, a solution that results in reduction of patient’s discomfort. It also restores mobility, significantly enhancing the patient’s quality of life. The first clinical trial experience of this approach has yielded very promising results.3
In cancer surgery, the primary goal is to completely excise the tumor. However, incomplete resection is sometimes the outcome. INTRABEAM can be used to improve local control of colorectal tumors. The value of INTRABEAM has also been demonstrated in the setting of laparoscopic hemicolectomy in patients with colon cancer and gastrectomy in patients with gastric cancer.4
In endometrial cancer – the most common malignancy of the female reproductive system – the use of INTRABEAM is also feasible and has some potential advantages compared to brachytherapy, which requires complex radiation protection. By comparison, INTRABEAM can be implemented without high investment costs.
First clinical trial evidence has proved that it is possible to create a homogeneous cylindrical dose distribution similar to 192Ir HDR afterloading, suggesting that INTRABEAM can be used effectively in this common female cancer.
The versatility of INTRABEAM is also displayed in the treatment of skin cancer. Particularly in the treatment of non-melanoma skin cancer, irradiation is an important therapy option. In a prospective study, it was shown that intraoperative radiotherapy with INTRABEAM was as effective in the management of non-melanoma skin cancer as conventional radiotherapy techniques. The well-known advantages of INTRABEAM – targeted radiation delivery, low shielding requirements, and cost effectiveness – also hold true for the treatment of skin cancer.5,6
Delivering a boost radiation intraoperatively with INTRABEAM has potential advantages in the treatment of oral cancers. After resection, the margins of the tumor can be sterilized immediately, which may have a positive impact on local recurrence rate. Additionally, the numerous sensitive structures in this anatomical region can be spared due to the steep fall-off of the low-energy radiation emitted by INTRABEAM. A geographical miss is unlikely since the applicator can be positioned directly in the tumor bed. First study data have convincingly demonstrated the value of this concept.7
1 Wenz F, Kraus-Tiefenbacher U: Intraoperative Radiotherapy for Breast Cancer, Uni-Med, 2011; 51
2 Vaidya JS, Tobias JS, Baum M, et al.: TARGeted Intraoperative radioTherapy (TARGIT): An Innovative Approach to Partial-Breast Irradition, Semin Radiat Oncol, 2005, 84-91
3 Wenz F, Schneider F, Neumaier C et al. Kypho-IORT – a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases. Radiat Oncol 2010; 5: 11
4 Lyadov KV, Yu A, Sinyakin S, Improvement of Curativity of Video-Assisted Surgery for Colorectal Cancer Due to Intra-Operative Contact Radiotherapy Using the INTRABEAM System. Poster abstract presented at the ISIORT annual meeting 2008, Madrid, Spain
5 Bodner WR, Hilaris BS, Alagheband M et al. Use of low-energy X-rays in the treatment of superficial nonmelanomatous skin cancers. Cancer Invest 2003; 21(3): 355-62
6 Locke J, Karimpour S, Young G et al. Radiotherapy for epithelial skin cancer. Int J Radiat Oncol Biol Phys 2001; 51(3): 748-5520 Bodner WR, Hilaris BS, Alagheband M et al. Use of low-energy X-rays in the treatment of superficial nonmelanomatous skin cancers. Cancer Invest 2003; 21(3): 355-62
7 Rutkowski T, Wygoda A, Hutnik M et al. Intraoperative radiotherapy (IORT) with lowenergy photons as a boost in patients with earlystage oral cancer with the indications for postoperative radiotherapy: treatment feasibility and preliminary results. Strahlenther Onkol 2010; 86(9): 496–501