Intraoperative Radiotherapy

Intraoperative radiation therapy (IORT) delivers a large single dose of 10 to 20 Gy to a tumor bed following surgical resection, during which the normal organs are physically moved out of the pathway of the radiation beam.59 Intraoperative radiation therapy using X-ray beams was first described more than 80 years ago. However, refinements in techniques for IORT delivery and the generation of relevant large animal and human data on normal tissue tolerances to these large single doses of radiation therapy have ushered in a modern era for IORT.60,61 It is now widely used for abdominal, pelvic, and retroperitoneal carcinomas and sarcomas as well as for some thoracic malignancies, extremity sarcomas, and head and neck cancers. The clinical experience to these tumor sites from large cancer centers throughout the world was recently summarized.62 Linear accelerators designed for external radiation therapy have been adapted to deliver electron beams with IORT applicators, which collimate the electron beams according to the size and the slope of the treating area. Presently, dedicated mobile IORT machines are also used. These machines generate electron beams only. Therefore, shielding issues are minimal, and the machines are designed to be suitable for use in regular operating rooms.

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