Douglas Martin
Clinical Director, Department of Radiation Oncology Arthur James Cancer Hospital and Richard Solove Research Institute The Ohio State University College of Medicine Columbus, Ohio, USA

Abstract:

Intraoperative radiation therapy (IORT) is the delivery of therapeutic radiation at the time of surgery. IORT delivers a single high dose treatment to the tumor bed while excluding sensitive normal structures resulting in improved local disease control with acceptable toxicity. Treatment is most effective when performed in a multimodality approach in combination with surgery, external beam radiotherapy preoperatively or postoperatively, and systemic therapy as indicated. The most common techniques used to deliver radiation in the operating room are intraoperative electron beam techniques or high dose rate brachytherapy.
           
IORT has been shown to improve local control and survival in many cancers with high local failure rates, including recurrent colorectal, gynecologic, and head and neck malignancies, retroperitoneal sarcomas, and other recurrent cancers. Emerging data is becoming available utilizing IORT for breast cancer as a boost or as primary radiotherapy following breast conserving surgery. Additional investigation is ongoing integrating IORT as primary therapy for locally aggressive malignancies including sarcomas and head and neck cancers.
           
IORT is beneficial for locally aggressive and recurrent malignancies, has a developing role in breast cancer patients, and as systemic therapies improve, will have an even greater role in improving local control for many primary and recurrent cancers.