Intraoperative radiotherapy

What is intraoperative radiotherapy (IORT)?

Intraoperative radiotherapy, abbreviated as IORT, refers to a special form of radiotherapy performed directly during a surgical procedure. This way, the exact region to be irradiated can be targeted and nearby structures can be protected better.

Apart from surgical removal of the tumor and chemotherapy, radiotherapy forms one of the three most important treatment approaches in cancer therapy. Radiotherapy is based on ionizing radiation, which can inhibit the growth of cells. The goal of this therapy is to stop the degenerated tumor cells from growing uncontrollably.

Radiotherapeutic procedures are carried out alone or in combination with other therapies. For intraoperative radiotherapy, it is combined with the surgical excision of cancer tissue. Especially in cases where a tumor has only been partially removed, the direct irradiation of the tissue during the operation provides major advantages. The main goal is to destroy the remaining cancer cells and therefore prevent tumor recurrence (new growth of the tumor).

What types of tumors are treated with IORT?

Intraoperative radiotherapy is particularly suitable for tumors adjacent to radiosensitive organs or in other words, tumors that border organs which are are easily damaged by radiation. This includes, for instance, nerve tissue, intestinal tissue or bladder tissue. As a result, functional disorders can develop here after radiotherapy.

This is why IORT is used, for example, to treat renal cell carcinoma or cancer of the rectum. It is also used for stomach and pancreatic cancer as well as malignant gynecological tumors or brain tumors.

How does intraoperative radiotherapy work?

Intraoperative radiotherapy is always paired with surgery, in which the primary goal is to remove the tumor tissue as thoroughly as possible. The precise procedure and extent of the surgical intervention will always depend on the localization and spread of the cancerous tissue.

The affected organ is first exposed and the surrounding structures are kept to one side. Then the tumor tissue is surgically removed and in many cases the tissue is then examined under a microscope in a so-called frozen section procedure. This allows the surgeon to determine, among other things, if the tumor has been completely removed.

After resection of the tissue, radiotherapy is performed. A special tube is often inserted into the surgical site for this purpose, through which the radiation dose is delivered. This only extends the procedure by around twenty to thirty minutes, while the patient remains under anesthesia for the entire duration.

After the radiation treatment, the surgical wound is closed again and the patient wakes up from the anesthesia.

Usually, this is followed by further radiation sessions, in which smaller doses of radiation are delivered from the outside to the relevant areas (percutaneous radiotherapy).

What are the benefits of intraoperative radiotherapy?

In recent years, intraoperative radiotherapy has become more and more established in cancer therapy thanks to its many advantages. Its biggest benefit is that the area to be irradiated can be precisely targeted by surgical preparation while nearby structures can simply be kept aside mechanically.

Although radiotherapy methods are continuously improving, conventional radiotherapy through the skin can never completely prevent adjacent structures from being unintentionally hit. During surgery, however, these sensitive tissues like intestinal loops or nerve structures can be kept out of the irradiation area and shielded from radiation exposure.

A crucial upside of this is that the radiation dose can be increased significantly compared to percutaneous radiotherapy. In many cases, up to 30% of the total radiation dose can be applied at once. This is referred to as a radiation boost.

Because the surgical procedure and radiotherapy are performed in one sitting, this method also saves patients time and expense. By using higher radiation doses, patients may potentially require fewer radiotherapy sessions.

What are the risks and side effects?

Just like any radiotherapy treatment, intraoperative radiotherapy involves certain side effects. Due to the improved potential of protecting surrounding tissue, however, the likelihood of functional limitations of surrounding organs is reduced. The procedure also significantly minimizes the risk of skin reactions following irradiation.

However, acute nausea, vomiting or fatigue may be experienced. Since intraoperative irradiation is usually followed by percutaneous irradiation, further side effects can occur. They include short-term skin and mucous membrane irritation and, after prolonged irradiation, damage to various organs. For example, this can lead to fibrosis or functional disorders of the irradiated tissue.

Which doctors and clinics specialize in intraoperative radiotherapy?

Being diagnosed with cancer is always a drastic event and confronts patients with the difficult decision of the appropriate treatment strategy. This requires the expertise of an experienced specialist. Often, interdisciplinary cooperation between oncologists, surgeons, radiotherapists and radiation oncologists is necessary.

Many patients can perceive the search for a competent specialist as tedious and stressful.

Our aim is to facilitate this process. This is why we have carefully evaluated all the specialists listed here and selected them according to their qualifications and experience. Take advantage of this opportunity to get in touch with our experts quickly and easily. All of them are looking forward to your treatment request.