IORT: Specialists and Information on Intraoperative Radiation Therapy

IORT stands for intraoperative radiation therapy. It is an umbrella term for various radiological procedures used in cancer treatment. Unlike standard pre- or postoperative radiation therapy, IORT is administered during the surgical procedure to remove the tumor.

Both electron beams and low-energy X-rays can be used in IORT.

In radiation therapy, high-energy (ionizing) radiation is directed at the tumor cells. When radiation is administered before or after surgery, the radiation must first penetrate the skin and surrounding tissue before reaching the tumor. However, the radiation dose must not be so high that it damages healthy tissue.

With IORT, on the other hand, surgeons expose the affected tissue and shield the surrounding tissue. This allows the radiation to target the tumor bed or the tumor directly.

The goal of the treatment is to reduce the risk of recurrence. The treatment is therefore intended to prevent the tumor from returning after surgery.

Common methods in cancer treatment include

• chemotherapy,
• radiation therapy, or
• surgical removal of the tumorous tissue as part of oncological surgery

. Often, treating physicians combine these methods. This allows them, for example, to

• reduce the size of the tumor before surgery or
• increase the chances of a complete cure.

When choosing a treatment method,

• the type of cancer,
• its stage, and
• the patient’s overall health

are important factors.

Radiation therapy involves the use of a linear accelerator. The clinic also needs the right equipment for IORT © VILevi | AdobeStock

IORT is now used in various medical applications. Many types of tumors can be treated with intraoperative radiation therapy, provided the clinic has the appropriate radiation equipment.

Tumors that are considered indications for IORT include, for example:

• Brain tumors
• Gastrointestinal tumors
• Head and neck tumors
• Skin cancer
• Breast cancer
• Bone metastases

Doctors often decide whether IORT is indicated during the surgery itself. As part of the procedure, the tumor tissue that has already been removed is frequently subjected to pathological screening. Based on the results, doctors make decisions regarding further treatment directly during the surgery.

In addition, doctors base their decisions on existing guidelines and the latest research findings.

Intraoperative radiation therapy is not an option for every patient. Certain criteria must be met.

Often, a tumor cannot be completely removed surgically. Even in these cases, high-dose radiation to the surgical site can support treatment.

Intraoperative radiation therapy has the following advantages:

• direct irradiation of the affected tissue,
• high precision,
• high-dose radiation without affecting surrounding tissues, and
• a shorter treatment duration for the patient.

High-dose radiation to the surgical site following tumor removal offers several benefits for patients:

• IOR is performed during surgery while the patient is under anesthesia: This spares patients what can sometimes be a stressful treatment process.
• Direct and precise radiation can shorten the overall treatment duration: Doctors administer 20–30% of the radiation dose during the surgery.
• For tumors with a low risk of recurrence, a single radiation treatment during surgery may be sufficient to ensure treatment success.
• Complications such as skin irritation or hair loss can be minimized with intraoperative administration.

For patients, intraoperative radiation therapy involves a longer period under anesthesia. Therapists require approximately 20 to 50 minutes to administer low-energy X-rays. Treatment with electron beams can be completed in as little as two to ten minutes.

In some specialized clinics, the radiation equipment is already integrated into the operating room. In others, doctors must first transfer the patient—while under anesthesia—from the operating room to the radiation therapy room.

Be sure to find out exactly which modalities are available at your clinic and what types of radiation therapy are offered. Your doctors should provide you with detailed advice on the advantages, disadvantages, and potential risks.

General information on radiation therapy can be found, for example, on the website of the German Cancer Research Center. Other informative sources include the German Society for Radiation Oncology (DEGRO) and the German Society for Nuclear Medicine (DGN).

Before IORT, the specialist provides the patient with comprehensive information about possible complications and side effects.

Although IORT causes virtually no radiation exposure to the skin, other side effects—such as

• fatigue,
• nausea and vomiting, or
• diarrhea

may occur. Complications related to the healing of surgical wounds have also been reported. Therefore, be sure to provide intensive wound care after treatment.

IORT is most often used as part of multimodal therapy. How effective it is for different types of cancer remains the subject of intensive research.

In many hospitals, doctors are already incorporating IORT into the treatment of breast tumors (breast cancer).

Intraoperative radiation therapy is considered a new approach in cancer treatment. If you would like to know whether IORT is a treatment option for you, please contact your treating physician directly.