The IOERT MethodFacing the challenge of fighting cancer!As pointed out by Prof. Wiegel (President of the German Cancer Congress, March 2010,in Berlin) cancer incidence will increase by more than 30% (!) within the next 20 years.Fighting this disease requires forward-looking methods and developments and theirimplementation.A hospital will only remain accepted by regional transferring physicians, health funds andespecially patients if it provides scientifically proven and efficient methods.This commitment requires target oriented investments, and sometimes also drasticalalterations of current procedures.Consumer organisations have announced that in future they will increasingly use their me-dical expertise to analyse all methods and procedures with respect to their efficiency. Thiswas also announced by the national AOK-Association, and similar signals were given bydifferent patient associations: after quality the efficiency has to be analysed.The challenge for any hospital will be to develop concepts with which they remain fit for pa-tient competition. A high-level and leading position is beneficial. What counts is a forward-looking and sustainable method.No doubt, IOERT i.e. intra-operative electron-beam radiation therapy is a revolutionary steptowards successfully fighting cancer in future. Whoever has gained experience with thishighly efficient method will never again choose a different way to fight cancer. No leadinghospital will reject such a knowledge.IOERT, which was developed simultaneously in Italy and the US 12 years ago, is now con-firmed by different scientific and randomised studies providing significantly better results inthe fight against cancer.It is obvious and logical: while conventional radiation therapy is possible only after thewound healing process (4-6 weeks later), the direct boost of the IOERT-Method eliminatesthe remaining cancer cells immediately.Now we wish to introduce you to the roots, the development and the current status of theIOERT-Method, which requires less heavy, mobile linear accelerators.
Those systems can be established directly in an operating theaterIOERTthe new intra-operative electron-beam radiation therapyA highlight for hospitals fighting cancer is the use of a mobile linear accelerator.I. The conventional way: cancer surgery and following percutaneous radiation and/or chemotherapyCurrently, the best organized and most consequent battle against cancer takes place forbreast cancer. The introduction of breast screening which visualises micro calcificationstypical for cancer growth allows the detection, diagnosis and treatment of minimal carci-noma in a well coordinated procedure conducted by medical specialists in more than 300breast cancer centers in Germany, following the standards of the S3-Guideline.Procedure, execution and coordination up to the point of psychological assistance of thepatients were significantly improved within the last years as consequence of the mammo-graphy study of Professors Hoeffken and Frischbier in 1994.Meanwhile, the early detection of carcinoma profits from the digitalisation of nearly all mam-mography sytems. Furthermore, medical specialists have improved their professionalknowledge and undergo quality assurance audits at regular intervals by their medical as-sociationsHowever, so far significant improvements in fighting breast cancer are still missing. Whileon one side tumors can be detected and treated earlier by increasingyly better organizedinterdisciplinary medical teams, the overheads have also increased, especially financially.Until now breast cancer is typically treated as follows: Once a breast carcinoma is detec-ted, surgery is usually unavoidable. After completion of wound healing, (around 5 weeksafter surgery) percutaneous radiation therapy follows, typically requiring 30 fractions withina time period of 6 weeks. Finally the patient is informed that with the radiation the cancerhas been defeated, but there is no complete security that further metastases may not ap-pear later on.
For this reason in many cases patients are advised to undergo additional chemotherapyin order to be sure that all preventive measures have been taken.Even though the conventional cancer operation with additional radiation and/or chemo-therapy has been improved in some areas, from the patientsʼ view there is no substantialchange. But this will happen soon!II. The new intra-operative electron beam radiation therapy (IOERT) against cancerSimultaneously with the German mammography study in 1993/1994 the Instituto Europeodi Oncologie (IEO) in Mailand (Prof. Umberto Veronesi, chair of gynaecology and Prof. Ro-berto Orecchia, chair of radiation therapy) initiated a development to move radiation the-rapy out of the “radiation bunker” and into the operation room close to the tumour operation.The plan is to give an efficient single radiation boost to the empty tumour bed and its bor-dering tissue. The radiation has a dermal tissue-penetration of around 2 to 4 cm, elimina-ting all microscopical residues of the tumour immediately with maximal probability.This bold idea, first as regarded impracticable, was strongly supported by Prof. Veronesiand Prof. Sedlmeier from Salzburg University Hospital. The former medium sized companyHitesys (High-Technology-Systems), Rome, was able to develop a light weight and mobileLinac (linear accelerator) which could be positioned in the operation room and thus replacethe heavy weight linear accelerators which weigh around 10 to 12 tons.Since Prof. Umberto Veronesi was also Italian health minister, he was able to spread thisrevolutionary technique across Italy so that nearly 65 mobile Linacs were installed in Ita-lian hospitals by 2010.After the operation, but still during narcosis, the patient receives a one-minute single ra-diation dose. This procedure, including the correct positioning of the Linac system, can beperformed within 15 minutes for all steps.In 10 years of experience this direct and efficient radiation therapy showed outstanding re-sults (see also the different studies which were published in Europe). The direct irradiationof the “empty” tumour bed provides such striking results that common postoperative mea-sures like external beam radiation therapy with up to 30 fractions has in many cases be-come obsolete.
III. Conclusion:For many women with a breast cancer, in future due to intra-operative electron beam ra-diation therapy postoperative irradiations are unnecessary.Apparently the “Deutsche Krebshilfe” has realised this “quantum leap” in radiotherapy andprovided financial support to install such a Linac (Novac 7) at the hospital of Düsseldorf Uni-versity (Prof. W. Budach, Prof. Bender and his successor Prof. Janni, gynaecology).It can be assumed that hospitals starting with this method early and installing such a high-light in cancer treatment will move up in rankings in the fight against cancer.All benefits shown by the example of breast cancer are equally valid in the treatment of sar-coma, rectal cancer, recurrent rectal cancer as well as urogenital tumours a. o..Also at University-Clinics in Aachen in Heidelberg and in Marburg a mobile linearaccelerator is available for intraoperative electron beam radiotherapy.In Germany we can see now a change in fighting cancer!