LIAC HWL
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Sordina IORT Technologies

Time zero between surgery and nadication “IntraOperative Radiation Therapy (IORT) in its broadest sense refers to the delivery of irradiation at the time of an operation. IORT evolved as an attempt to achieve higher effective doses of irradiation while dose-limiting structures are surgically displaced." “IntraOperative irradiation (IORT) refers to delivery of a single dose of irradiation to a surgically exposed tumor or tumor bed while the normal tissues are protected from the irradiation either by retracting the mobilized tissue or by shielding the anatomically fixed tissues. IORT has...

NO LONGER MOVING THE PATIGNT: the system follows the treatment, thus avoids the need of moving patients from the surgical table. TRANSPORT INTO STRETCHER ELEVATOR: the dimensions are such that LIAC HWL can be easily transported to the operating room through the use of any stretcher elevator. F-U N CTIONALITY IN MULTIPLE: OPERATING ROOMS: the system can be quickly moved via the dedicated remote control and utilized in any operating room, thus maximizing its employment.

HARD-DOCKING PROCEDURE: - fast and easy procedure that can be performed by expert teams in less than five minutes; - safe and executable in any clinical configuration, thanks to the LIAC HWL architecture and the wide range of accompanying applicators; - a reliable system that provides an accurate and repeatable beam collimation on the target. DEGREES OE FREEDOM: 3 independent degrees of freedom of the radiant head (elevation, roll angle and pitch), and 2 degrees of freedom of the mobile unit (shift on the plane) permit to easily reach any district.

LIAC HWL is able to treat any clinical volume in the lOeRT environment. By selecting the correct applicator/energy combination, it is possible to treat any neoplastic disease effectively and safely. The 1007o PMMA (polymethylmethacrylate) applicator allows: - implementation of the safest and fastest hard-docking technique; - direct visualization of the surgical breach, thanks to the transparency of the material and the length of the terminal applicator; - full compatibility with x-rays imaging; - increase of the surface dose by more than 907o, thus avoiding the need of any bolus. applicator...

The lOeRT technique ensures reduction of dose exposure of the healthy tissue during the irradiation. In breast cancer treatment, the use of a radioprotection disc (Italian Patent no. 1392099) temporarily inserted between the target and the chest wall fully protects the healthy tissue underneath. The disc is a medical device made of steel and PTFE (polytetrafluoroethylene), biocompatible and sterilizable materials; is available in the following diameters: 4,5,6,7, 8,9,10 and 11 cm. The disc has 4 holes placed along the crown, which allow adhesion to underlying tissues, thus ensuring their...

One of the limits to the easy and cheap implementation of an lOeRT program is represented by radiation protection. LIAC HWL has been specifically designed in order to minimize stray radiation: HWL stands for High WorkLoad, that is the number of patients per year that can be treated without going beyond the radiation protection admitted threshold. IMPROVED RAO PERFORMANCETHE MINIMUM POSSIBLE AMOUNT OF STRAY RADIATION, FOR THE HIGHEST POSSIBLE WORKLOAD. Any thickness and material under radioprotection standards requirements. I UpEtoirE NO ADDITIONAL BARRIER NOR MOBILE NEITHER FIXED, ARE...

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IOe»RT CAN BE: PERFORMED BITHBR A Ed: - SINGLE DOSE, a single treatment which replaces the entire external radiotherapy cycle. (ELIOT protocol for breast cancer) - BOOST, followed by a reduced external radiotherapy cycle. (HIOB protocol for breast cancer). Hard-Docking procedure Surgical removal of the tumor Target preparation surgery lOeRT irradiation r-^ [ DeRT SINGLE DOSE L f-or a selected class of patients L__A r lOeRT BDOEdT + 1 H YPOF-R ACTI □ N ATCD LCXTBRNAC RT CYCLEzJ

Waiting time External radiation therapy treatment between lumpectomy and radiation therapy Improvement of local control is a conditio sine qua non for disease free and overall survival. Reduction (in the case of boost) and elimination (in case of single dose) of the external radiotherapy cycle. Time zero between surgery and the delivery of radiotherapy, neoplastic cells growth from microscopic residual disease follows an exponential course immediately after surgery. Giving lOeRT this problem is solved. Precision, thanks to direct visualization of the target. Significant reduction of dose to...

1. The Salzburg concept of intraoperative radiotherapy for breast cancer: Results and considerations, Reitsamer R. et al., Int. J. Cancer. Vol.118. pp. 2882-2887.2006 2. Intraoperative (I0ERT) versus external electron boost in breast conserving-operated breast cancer patients. 10-year results of a matched-pair analysis [Abstract]. Fastner G. Reitsamer R. Kopp M. Menzel C. Glueck S. Merz F. et al.. Strahlenther Onkol 2011;187:73-4. 3.10RT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer; Long term results of an ISIORT pooled analysis. Fastner...

ASTRO GUIDELINES UPDATE: broader selection criteria In September 2016, ASTRO published the Update of the Accelerated Partial breast Irradiation (APBI) Consensus Statement in order to provide a guidance on use of I0RT for Partial Breast Irradiation (PBI) in early stage breast cancer [7]. On the basis of the published evidence and the mature results obtained thanks to the 5.8 years follow-up of the ELIOT trial, it has been recognized the efficacy of performing the I0RT with electrons. In details, the ASTRO society stated the following recommendations: - I0RT with electrons (lOeRT) can be used...

I0RT (applicator 8cm), Charlson comorbidity index < 3 and chemotherapy improve OS Median survival: 23 m RO vs 10 m R2/unresectable 987o local control with lOeRT boost I0RT with neoadjuvant CT and CRT improve survival. No toxicity incremented by lOeRT lOeRT significant improvement of LC Favourable effect of I0RT in pts with stage II and III Any stage lOeRT promoted local control Prognostic index for risk-adapted treatment No toxicity increment by lOeRT lOeRT and Preop CRT improve OS lOeRT advantage in pts with R1 and R2 resection No increase of acute and long-term complications In D210RT...