ELIOT: RADIOTHERAPY DURING SURGERY

The IEO’s vocation for ever more conservative treatment, thus respecting not only the clinical result but also aspects relative to the patient’s quality of life, is expressed through its introduction of one of the most sophisticated radiotherapy procedures: Electron IntraOperative Therapy (ELIOT).
ELIOT is a radiotherapy technique enabling high doses of radiation to be concentrated directly on the tumour in a single administration during surgery.

A mobile linear accelerator is positioned on the operating area and emits a dose of radiation equivalent to that traditionally administered during external radiotherapy, while significantly reducing side effects and tissue damage.
In fact, the ability to physically move away any healthy organs positioned between the radiation beam and the target reduces toxicity, while the direct view of the target region ensures maximum accuracy in dose administration.

In modern treatment strategies, ELIOT's therapeutic integration model enables:

• A more radical surgical procedure, as it eliminates any residual cancer.
• Intensified radiotherapy anti-cancer effect, due to the administration of overall radiation levels which would not be possible through external therapy only.
• Reduced time between surgical removal and radiotherapy, thus limiting the time which can condition the development and growth of residual cell clones.

The ELIOT technique was first used in the 1920s, but the inadequacy of the instruments available at that time greatly limited its use. Until recently, the main obstacle to its development and large-scale use was the need to transfer the anaesthetised patient, with an open surgical wound, from the operating theatre to the radiotherapy department and back again to complete the surgical procedure, with consequent organisational problems and increased risk of patient infection.

Intraoperative therapy at IEO

The availability of a new type of linear accelerator designed for direct use in the operating theatre has enabled IEO to incorporate ELIOT as one of its most promising research and treatment projects. In July 1999, the Institute achieved its objective of being at the cutting edge of ever more effective techniques, equipping an operating theatre with a linear accelerator specifically developed for this procedure. New generation linear accelerators dedicated to ELIOT are fitted with a robotic arm manoeuvrable over the operating area. These accelerators avoid the complications connected with patient transfer and prolong overall surgery by only 10-15 minutes.
ELIOT is mainly used for conservative treatment of early stage breast cancer. A single dose of radiation is administered directly into the residual mammary gland during surgery, after removal of the cancerous lump (quadrantectomy).

This technique significantly reduces the physical and psychological “weight” of breast surgery for small tumours: in fact, treatment is concentrated in just two days of hospitalisation.