Electron intra-operative therapy

Developed by Professor Umberto Veronesi, breast cancer specialist and former Minister of Health in Italy, in certain cases electron intra-operative therapy (ELIOT) could become a substitute for postoperative radiotherapy. As the new method undergoes clinical tests at the Breast Centre, Milan, Meike Lerner of European Hospital spoke with radio-oncologist Professor F-J Prott about current results and ELIOT's potential future in oncology

`ELIOT means that single-fraction radiation of 21 Gy is delivered directly to the tumour bed during a surgical intervention, to a depth of about 3 cm,´ Professor Prott explained.

Professor F-J Prott, Director of the RNS Clinic, St Josefs-Hospital, in...
Professor F-J Prott, Director of the RNS Clinic, St Josefs-Hospital, in Wiesbaden, Germany

‘Due to this procedure the procedure takes about 30 minutes longer than usual, but post-operative radiation therapy is no longer needed. Consequently, for most patients, the treatment is complete, with hospital discharge, and they don’t have to undergo out-patient radiation therapy, which could take up to six weeks. 
‘Since post-operative radiation of the entire breast and the surrounding tissue is no longer indicated, ELIOT is suitable only for a clearly defined group of patients. These parameters must be present: the patient is older than 50 years; the tumour is not larger than 2 cm (T1) and no lymph nodes are affected (N0). The histological degree is maximum G2 and there must be no indications of metastases. The surgeon has to be extremely careful to remove any traces of tumour-carrying tissue. 
‘Due to today’s advanced diagnostic methods, the number of early detections and thus of T1/N0 tumours is increasing constantly. However, many women with such early detected tumours are under 50 years old, so are not eligible for this kind of intra-operative radiotherapy.
‘Despite these limitations, the first clinical results are very promising. A study at the Milan Breast Centre, involving 1,600 patients, showed that only 2.8% of the women suffered fibroses and the recurrence rate was 1.6%. That means, compared with conventional methods, ELIOT showed 1-2% less fibroses and even 2% less recurrences. However, these figures are only valid for Milan. It remains to be seen whether other hospitals will be able to achieve similar results.  
Currently, ELIOT is only used for research. In view of its apparent advantages, when might it be clinically introduced?
‘It’s without a doubt a very interesting method and there is a clear trend towards ever more targeted and precise radiation therapies, moving away from large area radiation. However, we must acknowledge that the conventional method – breast-conserving surgery followed by about 30 radiation sessions – is also very successful. Moreover, we were able to reduce side effects, particularly skin changes on the breast, so we have a method that’s tried and true and which has been constantly improved. As far as the current status of ELIOT is concerned, I’d rather go for “never touch a running system”. Having said that, I also want to point out again that ELIOT means there is only intra-operative radiation. As a boost, I mean an addition to whole-breast radiation therapies, intra-operative methods are allowed and may be applied outside studies. That means, during surgery a boost of about 10 Gy is applied and a conventional breast radiation therapy of about 46-50 Gy follows. This procedure reduces the post-operative radiation by one week, that’s five sessions.
In short, I look very optimistically upon ELIOT and I think it’s an important goal to make breast cancer therapy as stress free as possible. Nevertheless, we must not act prematurely, that means long-term and large-scale studies are needed before the method is introduced in to everyday practice. In my opinion that will take another few years of intensive research before we might be able to use ELIOT without reservation in every day oncological work.’


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