Intraoperative radiation therapy opportunities for clinical practice normalization: Data recording and innovative development

Background Intraoperative radiotherapy (IORT) refers to the delivery of a high dose of radiation at the time of surgery. Aim To analyze clinical and research-oriented innovative activities developed in a 17-year period using intraoperative electron-radiation therapy (IOeRT) as a component of treatment in a multidisciplinary approach for cancer management. Materials and methods From 01/1995 to 03/2012 IOeRT procedures were registered in a specific Hospital-based database. Research and developments in imaging and recording for treatment planning implementation are active since 2006. Results 1004 patients were treated and 1036 IORT procedures completed. Median age of patients was 61 (range 5 months to 94 years). Gender distribution was male in 54% of cases and female in 46%. Disease status at the time of IORT was 796 (77%) primary and 240 (23%) recurrent. Cancer type distribution included: 62% gastrointestinal, 18% sarcoma, 5% pancreas, 2% paediatric, 3% breast, 77 7% oligotopic recurrences, 2% other. IORT technical characteristics were: Applicator size 5cm 22%, 6cm 21%, 7cm 21%, 8cm 15%, 9cm 6%, 10cm 7% 12cm 5% 15cm 3%. Electron energies: 6MeV 19%, 8MeV 15%, 10MeV 15%, 12MeV 23%, 15MeV 19%, 18MeV 6%, other 3%. Multiple fields: 108 (11%). Dose: 7.5Gy 3%, 10Gy 35%, 12Gy 3%, 12.5Gy 49%, 15Gy 5%, other 5%. Conclusion An IORT programme developed in an Academic Hospital based on practice-oriented medical decisions is an attractive interdisciplinary oncology initiative proven to be able to generate an intensive clinical activity for cancer patient quality care and a competitive source of scientific patient-oriented research, development and innovation.