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Intraoperative Radiation Therapy (IORT)

Intraoperative radiation therapy (IORT) from ZEISS enables a targeted, risk-adapted and interdisciplinary treatment of tumors. By using low energy x-rays intraoperative radiation can be given with a high dose, precisely into the tumor or directly after resection to the tumor bed.

Radiation with INTRABEAM® from ZEISS enables an individual treatment ensuring that skin and deeper structures are protected and a shorter duration of the radiation therapy compared to external beam radiation therapy (EBRT). This can also reduce associated side effects and enhances treatment comfort for the patient – a key element in increased quality of life.1

 

 

Oncological Indications

 

Brain Tumors

For brain tumors, postoperative dose reconstructions demonstrated that in many patients the post-resection cavities are normally of complex shape and the treatment by a spherical applicator with an isotropic dose distribution is the only feasible way avoiding angle errors.Consequently newly diagnosed brain tumor patients showed good local tumor control with relatively good long term survival.3

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Breast Cancer

Radiation therapy is an important element of the breast-conserving treatment for the mamma carcinoma. With intraoperative radiation therapy, radiation is given with a spherical applicator targeted to the area where the risk of recurrence is highest, directly into the tumor bed right after tumor resection. The effectiveness of the TARGIT method for breast cancer treatments is confirmed by the TARGIT-A study and is already used in many breast cancer centers worldwide.1

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Gastrointestinal Tumors

In cancer surgery, the primary goal is to completely excise the tumor. However, incomplete resection is sometimes the outcome. By using intraoperative radiation with the INTRABEAM® local control of colorectal tumors, locally advanced and recurrent rectal cancer can be improved compared to EBRT.4,5

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Head & Neck Tumors

In general, for IORT no differences in postoperative complications compared to EBRT have been found.6 This is a result of different factors: first, due to the precise and targeted delivery of radiation directly and only to the target volume, and second, with IORT the normal tissue and sensitive structures in the head and neck area can be spared.

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Skin Cancer

The versatility of the INTRABEAM® is also displayed in the treatment of skin cancer using electronic brachytherapy with photons. For the treatment of non-melanoma skin cancer, kilovoltage irradiation is an important therapeutic option which is also suitable for patients with a high operative risk.7

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Spinal Metastases

Kypho-IORT, a combination of intraoperative radiation and Kyphoplasty, enables the sterilization of the metastasis and offers immediate stabilization with pain reduction as the radiation exposure takes place directly in the target volume. The combined procedure of Kypho-IORT offers immediate structural stabilization and provides local control of the tumor growth.8

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Products

 

INTRABEAM 600

As third device generation of IORT from ZEISS, the new INTRABEAM 600 is the first fully integrated and connected treatment platform for IORT addressing multiple clinical needs in one solution.

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INTRABEAM System

The second device generation of IORT from ZEISS is the INTRABEAM System*, which is the only intraoperative radiation device used for the Phase III randomized trial "TARGIT-A" with more than 12 years of clinical study expertise.

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Applicators

In each IORT the best possible irradiation of the tumor or the tumor bed respectively the irradiation of non-melanoma skin tumors using electronic brachytherapy with photons has to be ensured. Hence, ZEISS offers multiple applicators which ensure, depending on the type, size and shape of the tumor, an adapted geometric dose distribution to the target tissue.

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Training & Service

TARGIT Academy

For INTRABEAM® users, the TARGIT Academy offers a practical first hand training course including an intensive hands-on training which is conducted on a peer-to-peer basis from experts for experts in the field of IORT/ electronic brachytherapy. Due to the fact that the learning curve increases immediately the TARGIT Academy is equally suitable for all users.

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IORT Service

The IORT Service for the INTRABEAM® is an individual service package consisting of specialized service units according to customer requests, a straightforward device loaner concept and regular on-site inspections. With this concept an exact performance of the radiation source can be ensured at the customer site.

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* The ZEISS INTRABEAM System consists of: INTRABEAM PRS 500 with XRS, INTRABEAM Cart and NC32 INTRABEAM Floor Stand

  • 1 Vaidya, J. S., Wenz, F., Bulsara, M., Tobias, J. S., Joseph, D. J., Keshtgar, M., … Baum, M. (2014). Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. The Lancet, 383(9917), 603–613.
  • 2 Giordano, F. A., Brehmer, S., Abo-Madyan, Y., Welzel, G., Sperk, E., Keller, A., … Wenz, F. (2014). INTRAGO: intraoperative radiotherapy in glioblastoma multiforme – a Phase I/II dose escalation study. BMC Cancer, 14(1), 992.
  • 3 Han, X., Fu, B., Wu, M., Zhang, H., Li, D., Zhang, J., … Sun, S. (2014). Intraoperative Radiotherapy with INTRABEAM in primary brain tumors after resection: Preliminary reports of 26 cases. Neuro-Oncology, 16.
  • 4 Guo, S., Reddy, C. A., Kolar, M., Woody, N., Mahadevan, A., Deibel, F., … Suh, J. H. (2012). Intraoperative radiation therapy with the photon radiosurgery system in locally advanced and recurrent rectal cancer: retrospective review of the Cleveland clinic experience. Radiation Oncology, 7(1), 110.
  • 5 Algur, E., Mahadevan, A., & Deibel, C. (2005). Interstitial photon radiosurgery system for re-current and locally advanced rectal cancer: a retrospective review of 24 patients. ASCO Gastrointestinal Cancers Symposium, Jan 27–29, Hollywood, Florida, USA, Abstract No 208.
  • 6 Rutkowski, T., Wygoda, A., Hutnik, M., Składowski, K., Wydmański, J., Maciejewski, A., … Maciejewski, B. (2010). Intraoperative Radiotherapy (IORT) with Low-Energy Photons as a Boost in Patients with Early-Stage Oral Cancer with the Indications for Postoperative Radiotherapy. Strahlentherapie Und Onkologie, 186(9), 496–501.
  • 7 Cognetta, A. B., Howard, B. M., Heaton, H. P., Stoddard, E. R., Hong, H. G., & Green, W. H. (2012). Superficial x-ray in the treatment of basal and squamous cell carcinomas: a viable option in select patients. Journal of the American Academy of Dermatology, 67(6), 1235–41.
  • 8 Wenz, F., Schneider, F., Neumaier, C., Kraus-Tiefenbacher, U., Reis, T., Schmidt, R., & Obertacke, U. (2010). Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases. Radiation Oncology, 5(1), 11.
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