Abstract
Purpose: A mobile linear accelerator, the Mobetron (IntraOp, CA), is the first dedicated intraoperative radiotherapy (IOeRT) Linac with electron beams installed in Canada. The promise of IOeRT is to allow direct irradiation of the tumour bed at the time of resection while healthy tissues are moved out of the way or protected from the radiation with an internal shield. Extensive collaboration between multiple departments (radiation oncology, radiation protection, sterilization and surgery) as well as teamwork among different professionals (anesthetists, nurses, medical physicists, radiation oncologists, surgeons, technologists, etc.) were necessary to build a successful IOeRT program.
Materials and Methods: Medical physicists were responsible for commissioning and radiation surveys of the dedicated shielded operating room (OR). New accessories were locally developed using 3D printing. The clinical process was drafted and tested by the multidisciplinary team. Dry-runs in the OR with their staff were done to identify the necessary modifications to the standard surgical procedure as well as ensure proper OR staff training for radiation safety. Further quality control was obtained by performing in vivo measurements during treatment. An international multi-center prospective study was joined to standardize the early breast IOeRT practice and compare the initial results to established centers.
Results: Locally acquired output factors and percent depth doses compared well with available data. The in vivo measurements confirmed proper cone and shield positioning within the patients. Since February 2020, 28 breast patients have benefited from IOeRT treatments with positive follow-up and without adverse outcome, mostly receiving definitive treatments and for a few patients, boosts. Furthermore, starting in February 2023, the technique has been extended to digestive intraoperative radiotherapy (DIRT), which necessitated new clinical processes drafted by the multidisciplinary team.
Conclusions: A strong multidisciplinary collaboration is necessary to a successful implementation of IOeRT in the clinic. This collaborative effort must be maintained to improve and innovate upon the technique.
