The Italian “iort Project”

The “Intra Operative Radiation Therapy” (IORT) represents the latest technological frontier in radiotherapy. The technique utilizes accelerated electrons, as from a tailored designed EB-machine, to destroy rapidly spreading malignant cancer cells and it is appraised to allow a 15% general increase of cancer patients survival. The Italian “IORT Project”, funded by the Italian Ministry of Research (MURST), was started in 1998 from ENEA (Italian National Agency for New Technologies, Energy and the Environment) and is aimed to design and construct two innovative IORT systems as direct enlarged improvement of present IORT-NOVAC7 system, jointly developed in the latest years from ENEA and the Italian Hitesys Company. The paper, after a short review of the NOVAC7 features, will describe the “IORT Project” progress status, focusing attention on both innovative technical aspects of future IORT accelerators, and first prototype early experimental results. 1 INTRA-OPERATIVE RADIOTHERAPY Radiotherapy of cancer patients to destroy rapidly spreading malignant cancer cells is well known and the IORT technique [1] represents the most recent and advanced technique of radiotherapy application, allowing the delivering of a single high dose (as from accelerated electrons beams) on a tumour bed soon after surgery excision and inside the surgery theatre, avoiding the patient treatment several days after the tumour resection or (traditional and previous IORT) the patient transfer to the hospital radiotherapy shielded department just after the resection. According to such previous IORT technique, the patient, after surgical excision, was submitted to a radiotherapy treatment carried out in a different hospital area, suffering an additional anaesthesia to cover transfer time to therapy division and back to operating room, and, moreover, being exposed to risks connected to difficulties to preserve a sterile path during conveyance. The new IORT technique overcomes the above problems: ENEA and HITESYS, since early 90s, started to develop a system, exclusively conceived for intraoperative treatments, allowing to perform IORT application without moving patients and with no structural modification of the operating room. The new system, named NOVAC7 [2], commercialised by Hitesys Co. since 1997, is at present fully operative by seven different hospital in Italy and abroad, and over 200 patients were already submitted to NOVAC7 treatment confirming the process effectiveness and foreseen survival figures. The main advantage of IORT technique is to be referred to the improved tumour local control [3]: in fact the technique allows the hitting with an high single dose only of tumoral tissue, avoiding to submit to radiation normal tissues and avoiding tumour recurrence in that area. In such a way, IORT represents a gain of surgical excision (the smaller is the residual disease after surgery, the smaller is the cancer recurrence and the greater is the effectiveness of complementary therapies) and a gain of radiotherapy treatment (as it exploits the radiobiological effect of a single high dosage which usually is more effective on tumoral tissues). Final result, as from a large scientific medical literature, is an improved patients survival, calculated, with reference to a large oncologic spectrum, as more of 15 % in the five years after surgical resection. The “IORT Project”, was started in 1998 from ENEA, the main governmental Italian agency for technological research, on a budgetary program funded by the Italian Ministry of Research (MURST). The Project aim is to design and construct two innovative IORT systems as direct enlarged improvement of present Italian IORTNOVAC7 system, to be considered at present as the most advanced system at worldwide level. 1.1 The ENEA-Hitesys NOVAC7 system The NOVAC7 system is a robotic mobile intraoperative electron beam unit (see Fig 1 and table 1). Table 1: NOVAC7 technical data Nominal Energy 3, 5, 7, 9 MeV