Intraoperative Radiation Therapy (IORT) with Intrabeam 600

What is IORT (intraoperative radiation therapy)?

IORT (intraoperative radiation therapy) delivers radiation to the tumour bed during breast surgery itself, using the Intrabeam system. For eligible patients it can replace several weeks of external radiation with a single dose given in the operating room — reducing treatment time and limiting the dose to nearby organs.

Assoc. Prof. Dr. Youwanush Kongdan

Breast cancer treatment has rapidly advanced, with breast-conserving surgery combined with intraoperative radiation therapy (IORT) becoming an effective and increasingly popular method. This approach offers numerous benefits, helping patients recover quickly and improving their quality of life.

Breast-Conserving Surgery

Breast-conserving surgery involves removing only the cancerous lump and surrounding tissue, preserving as much of the breast’s shape as possible. Patients then receive radiation therapy to eliminate any remaining cancer cells. This is typically done through Whole Breast Radiation (WBR), covering the entire breast for about 20-25 sessions. Additionally, Boost Radiation may be applied to the cancer site for another 1-2 weeks.

Intraoperative Radiotherapy (IORT)

IORT is a technique where localized radiation is administered during surgery using an Intrabeam device. In Thailand, there are two hospitals equipped with Intrabeam devices, available in two models: Intrabeam 500 and Intrabeam 600. Namarak Hospital uses the latest Intrabeam 600 model.

Advantages of IORT:

1. High Efficiency and Precision: Radiation can be administered immediately post-surgery, accurately targeting the required area, thereby enhancing the elimination of residual cancer cells.

2. Reduced Postoperative Radiation Frequency: Patients do not need frequent hospital visits for additional radiation, reducing daily life disruption and saving time.

3. Protection of Normal Tissue: Intrabeam focuses radiation specifically on the cancerous area, minimizing impact on surrounding normal tissue and reducing unwanted side effects.

4. Quick Recovery: Fewer radiation sessions post-surgery allow for faster patient recovery, enabling a quicker return to daily activities compared to traditional treatments.

5. Enhanced Confidence: Utilizing advanced, effective technology helps patients feel confident and less anxious about their treatment.

Suitable Candidates for IORT:

IORT is appropriate for early-stage breast cancer patients whose cancer has not spread beyond the breast. The decision to use IORT involves evaluation with a specialist, considering factors such as tumor size, location, and pathology. Breast-conserving surgery combined with IORT is a good treatment option, preserving patients' appearance and confidence.

Procedure for Surgery and IORT with Intrabeam 600

Using Intraoperative Radiation Therapy (IORT) with Intrabeam 600 is a modern technology for breast-conserving surgery (BCS). During the procedure, after the cancerous lump is removed, a lead or protective material is placed at the wound base to prevent radiation from affecting the chest organs, such as the lungs and heart. The Intrabeam 600 device then irradiates the wound cavity for about 30-45 minutes, targeting areas at high risk of recurrence. The protective material prevents radiation from impacting deeper chest tissues and organs. The entire surgery and radiation process takes about 2-3 hours.

Research Supporting IORT Effectiveness:

1. TARGIT A Study:

   • Objective: To evaluate the effectiveness and safety of targeted intraoperative radiotherapy (IORT) in breast-conserving surgery patients.

   • Findings:

     • Recurrence Rate: IORT 2.1% vs. Traditional Radiation 1.1%

     • 5-Year Survival Rate: IORT 93.9% vs. Traditional Radiation 92.9%

     • Conclusion: IORT is nearly as effective as traditional radiation in the TARGIT A study.

2. TARGIT B Study:

   • Objective: To assess the effectiveness of using IORT as a boost in treating moderate-stage breast cancer, compared to traditional external beam radiotherapy (EBRT).

   • Findings:

     • Recurrence Rate: IORT Boost 3.3% vs. Traditional EBRT 2.6%

     • 5-Year Survival Rate: IORT Boost 89.6% vs. Traditional EBRT 88.8%

     • Conclusion: IORT Boost shows satisfactory results for moderate-stage breast cancer, comparable to traditional EBRT.

3. TARGIT E Study:

   • Objective: To evaluate the effectiveness and safety of IORT for elderly, low-risk breast cancer patients, compared to traditional EBRT.

   • Findings:

     • Recurrence Rate: IORT 1.5% vs. Traditional EBRT 1.3%

     • 5-Year Survival Rate: IORT 94.2% vs. Traditional EBRT 94.5%

     • Conclusion: IORT is a viable treatment for elderly, low-risk patients, with outcomes similar to traditional EBRT.

4. TARGIT-US Study:

   • Objective: To assess the effectiveness of IORT in breast cancer patients in the United States.

   • Findings:

     • Recurrence Rate: Less than 2% for IORT-treated patients

     • Side Effects: Fewer side effects and faster recovery compared to traditional radiation.

Conclusion:

Namarak Hospital has adopted the Intrabeam 600 for Intraoperative Radiotherapy (IORT), with a team of expert doctors and nurses ready to provide close consultation and care. For more information about IORT or breast cancer treatment, patients are encouraged to consult directly with their physician.

Frequently Asked Questions (FAQ)

How is IORT different from external radiation?

IORT gives a single dose in the operating room directly to the tumour bed, while external radiation requires many sessions over weeks. IORT is more convenient and spares nearby tissue.

Who is suitable for IORT?

Typically patients over 45 with a single small, low-grade, hormone-receptor-positive tumour. Eligibility is assessed individually against defined criteria.

How many IORT sessions are needed?

For fully eligible patients, a single intraoperative dose may be sufficient.

Is IORT safe?

In well-selected patients, studies show comparable disease control with fewer side effects to skin, heart, and lungs.

Does Namarak offer IORT?

Yes — Namarak has the Intrabeam system for intraoperative radiation, one of its signature technologies.

Related reading

• Breast cancer treatment: complete guide

• Breast cancer surgery guide

Disclaimer: This information is for general education only and is not a substitute for personalised medical advice. Please consult a qualified specialist.