Intraoperative radiotherapy with electrons in breast surgery

Partial breast irradiation (PBI) after conservative surgery is a procedure whichis gaining ground in breast cancer treatment with encouraging results. PBI usespin-point radiation fields on a limited involved portion of the breast rather thanthe whole organ. Intraoperative radiotherapy (IORT) is a type of PBI which hasbeen utilised in the last few decades to irradiate, with an external single dose,different types of tumours, mainly in the abdominal cavity during surgery. Thelimitation of its use, due to the need to transfer the patient from the surgicaltheatre to the Radiotherapy Department during surgery, was recently overcomeby the availability of mobile linear accelerators which can enter the surgicaltheatre.We developed in 1999 the idea of combining the two procedures (PBI andIORT) to irradiate the breast during conserving surgery in a single session andwe started a series of clinical studies whose preliminary results were previouslyreported. With the new technique (which we defined ELIOT - ELectronIntraOperative Therapy) the mobile linear accelerator delivers a single dose ofradiation with electrons to the involved quadrant of the breast during surgery,shortening the radiotherapy course from 6 weeks to one single session duringsurgery.We report our experience on a series of over 4000 invasive breast cancerpatients treated with ELIOT during breast conservative surgery from 1999 to2012 at the European Institute of Oncology.