IORT is a promising technique but limited by the technical and logistic problems already outlined. The continued development of conformal planning and delivery techniques for EBRT will reduce the therapeutic gain that can be obtained from intra-operative treatment. In addition, conformal radiotherapy (CRT) is more reproducible in set-up and dosimetry and poses no special radiobiological problems as in most cases fractionation is not changed significantly.

The lack of phase III data is likely to limit the development of IORT and restrict its use to specialist centres with a research base for evaluation of long-term results. At present, IORT cannot be regarded as part of mainstream radiation oncology practice.

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