Bellvitge Hospital and the ICO incorporate intraoperative radiotherapy into the surgical procedure to improve the treatment of two types of brain tumors

It is an innovative strategy, in the evaluation phase, which offers a more early and accurate therapeutic option against some tumors with a poor prognosis.

The Functional Unit of Neurooncology HUB-ICO is among the pioneering European centers in the application of this procedure

The new Bellvitge surgical block, with 3 hybrid operating rooms, is equipped with the most advanced technology to carry out these interventions

Specialists from the Bellvitge University Hospital (HUB) and the Catalan Institute of Oncology (ICO) are pioneering the application of intraoperative radiotherapy to the treatment of two types of brain tumors, as part of separate therapeutic evaluation studies. The goals of this innovative procedure are to reduce the risk of tumor recurrence, preserve the part of the brain unaffected by the side effects of radiation, and increase disease control. Intraoperative radiotherapy is a procedure applied for a few years to breast cancer and pelvic tumors, which is now also being used in neurooncology.

The neurosurgery team first removes the tumor from the patient and then, during the same surgical session, the radiotherapy oncologist enters the operating room and applies radiation therapy to the bed of the tumor that has been removed. In this phase, the specialist is assisted from the outside, by remote connection, by a radiophysicist and an anesthetist. The interventions take place in a hybrid operating room of the Bellvitge University Hospital equipped with an intraoperative CT and radiological protection by means of plumb walls, in which the intraoperative radiation device is adapted.

The HUB-ICO Functional Neurooncology Unit has been one of the first European centers to start applying this innovative procedure to the treatment of some brain tumors for more than a year. One of the two studies in which he participates is called INTRAGO-II (Intraoperative Radiation Therapy in Newly Diagnosed Glioblastoma). This is the only international trial comparing the results of the addition of intraoperative radiotherapy to conventional treatment for glioblastoma multiforme, the most common primary brain tumor. The trial is led by the University of Mannheim (Germany) and involves more than 20 hospitals in Europe and America.

The ICO-HUB was the first Spanish center to join, and has so far contributed 13 patients to the clinical trial. Dra. Anna Lucas, radiotherapy oncologist at the HUB-ICO Neurooncology Functional Unit and principal investigator of the INTRAGO-II trial, points out that “using this tool, only the first centimeter of brain tissue adjacent to the wall of the cavity can be irradiated tumor, where the risk of recurrence is higher, and thus preserve the rest of the brain from the side effects of radiation. He adds that, with this strategy, "the aim is to increase the dose administered in this area with the highest risk and, consequently, to increase the chances of controlling the disease". He explains that in glioblastoma, dose escalation has already been attempted with other techniques but has not been achieved without causing damage to the rest of the brain, which is why he is confident that this focused radiation can be achieved.

For his part, Dr. Miquel Macià, radiotherapy oncologist of the Functional Unit of Neurooncology HUB-ICO and principal investigator of the INTRAMET trial, adds that “unlike previous prototypes, the device currently used has an articulated arm and spherical applicators that optimize the administration of the treatment, since the applicator has to be in perfect contact with the surface of the cavity not to leave areas infradosificados ”. In the case of metastases, he emphasizes the “beneficial radiobiological effect of administering adjuvant treatment to surgery in a single dose and immediately, avoiding cell repopulation during the delay time due to the start of treatment in the case of external radiotherapy ”.