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What Is IORT for Cancer?

Medically Reviewed by Laura J. Martin, MD on June 12, 2020

Radiation is often part of your treatment for cancer. With IORT, or intraoperative radiation therapy, you get radiation in a very targeted way.

For some cancers, it can work as well as traditional radiation. And it has the advantage of protecting healthy cells from radiation damage.

What Is IORT?

IORT is a high dose of radiation that you get as part of your surgery.

Because IORT radiation is aimed right where your tumor was removed, the dose can be up to 2½ times higher than a safe dose of traditional radiation. This helps keep cancer from coming back in the same place.

How IORT Is Done

After your surgeon removes your tumor, they show the radiation oncologist (a specialist in radiation for cancer) where any leftover cancer cells are likely to be. Healthy tissues and organs are covered or gently moved out of the way.

The radiologist then does IORT on the area. You’re under anesthesia the whole time.

Sometimes, you get IORT with radioactive "seeds" inside a special kind of mesh. The mesh is cut to fit the area being treated, and the surgeon sews it into place.

The seeds deliver treatment where it's needed until their radiation runs out. The mesh stays in your body but dissolves over time.

Doctors use this type of IORT for certain types of cancer, such as pancreatic cancer, where it's hard to protect your other organs during the treatment.

Which Cancers Are Treated With IORT?

Doctors can use IORT on many types of cancer, including:

  • Those that are likely to return in the same area after surgery, like colorectal cancer and soft-tissue cancers called sarcomas
  • Some bladder and prostate cancers
  • Head and neck, endometrial, cervical, or kidney cancer that has come back

You may also get IORT when you have a lumpectomy for breast cancer. It could be right for you if:

  • Your tumor is small.
  • The cancer hasn’t spread to your lymph nodes.
  • You’re over 60.
  • You don’t have a mutation (change) in your BRCA genes. These genes usually protect against breast cancer, but a mutation keeps them from working well.

IORT and Other Treatments

IORT can be used along with traditional radiation, called external beam radiation therapy (EBRT). You might have traditional radiation before surgery to shrink your tumor, then get IORT during your operation.

Or, if you'll need EBRT after surgery, having IORT can mean you'll get less external radiation afterward. You might also get IORT if you’ve already had traditional radiation and it’s not safe for you to get it again.

IORT is sometimes used to help relieve pain and other cancer symptoms if you have a tumor that can't be removed with surgery.

The Benefits

Because IORT is done as part of your cancer surgery, you don’t have to wait to heal before getting radiation. So any cancer cells the surgery missed don’t have a chance to multiply.

Since IORT may harm fewer cells than traditional radiation, it's especially useful when the cancer is near important organs and structures like your:

IORT doesn’t have as many side effects as traditional radiation. You’re not likely to get red skin. IORT also may save you from going to radiation appointments over many days or weeks.

Even if you do need traditional radiation later on, your doses tend to be smaller.

The Risks

Studies that looked at complications after major cancer surgery plus IORT have found problems like:

But they found that the issues are usually related to the surgery itself, and that IORT didn’t make them worse.

One problem is that IORT doesn’t give your doctor time to test your tumor after surgery to figure out the best way to treat it.

This is especially true when you get it during a lumpectomy for breast cancer. IORT also requires general anesthesia, which you don't usually get for a lumpectomy.

Possible side effects of IORT are:

  • Fatigue
  • Skin irritation
  • Bruising or fluid buildup in your breast, if you get it for breast cancer

What to Expect

Since you get IORT during surgery, you don’t need to do anything special to prepare for it. It may add up to 30 minutes to the time you’re in the operating room.

If you're also using other treatments, like chemo or traditional radiation, your doctor will help you figure out when to start them once you heal from surgery.

WebMD Medical Reference

Sources

SOURCES:

ECancerMedicalScience: "Intraoperative radiotherapy: review of techniques and results."

Journal of Surgical Oncology: "Postoperative complications following intraoperative radiotherapy in abdominopelvic malignancy: A single institution analysis of 113 consecutive patients."

Memorial Sloan Kettering Cancer Center: "Intraoperative Radiation Therapy," "Radiation Therapy for Rectal Cancer."

Cedars Sinai: "Intraoperative Radiation Therapy."

University of California, San Francisco: "Intraoperative Radiation Therapy."

Advances in Radiation Oncology: "The CivaSheet: The new frontier of intraoperative radiation therapy or a pricier alternative to LDR brachytherapy?"

Mayo Clinic: "Intraoperative Radiation Therapy."

Radiation Oncology: "Intraoperative radiotherapy in gynaecological and genito-urinary malignancies: focus on endometrial, cervical, renal, bladder and prostate cancers," "Intraoperative radiation therapy (IORT) in soft-tissue sarcoma."

Rush University Medical Center: "Intraoperative Radiation Therapy."

CA: A Cancer Journal for Clinicians: "Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies."

Hackensack Meridian Health: "Intraoperative Radiation Therapy for Breast Cancer."

Practical Radiation Oncology: "Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement."

Cleveland Clinic: "Breast Cancer: Intraoperative Radiation Therapy (IORT): Risks/Benefits."

Brachytherapy: "The American Brachytherapy Society Consensus Statement on Intraoperative Radiation Therapy."

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