Intraoperative radiotherapy

A fundamental problem with radiotherapy is targeting diseased tissues while avoiding unaffected normal structures. Various approaches are possible including:

♦ Increasing sophisticated planning and treatment delivery for external beam radiotherapy (EBRT)

♦ Brachytherapy

♦ Radio-immunotherapy

♦ Boron neutron capture therapy (BNCT)

♦ Intra-operative radiotherapy (IORT)

There is some overlap between these techniques e.g. implantation of brachytherapy sources will be done under general anaesthetic for a variety of diseases, including prostate cancer, and can thus be termed 'intra-operative'.

The attraction of IORT is that affected tissues can be surgically exposed and selectively treated with reduced morbidity to non-affected tissues The principal drawback is the need for specialist additional equipment in the operating theatre. Also, there is a consequent increased need for radiation protection for staff in the presence of therapeutic (as opposed to diagnostic) radiation exposure. The need for the radiation oncologist to be present throughout imposes a further constraint on IORT compared to EBRT where patients can be treated without this requirement.

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