What is Intraoperative Radiation Therapy (IORT)? Purpose, Procedure & Results

Intraoperative radiation therapy (IORT) is a specialized cancer treatment that delivers focused radiation directly to tumor sites during surgery. Think of it as a precise, targeted approach where your surgical team can treat cancer cells right at the source while you're already in the operating room.

This technique allows doctors to deliver higher doses of radiation with remarkable precision, protecting healthy tissues that would normally be in the radiation path. It's like having a skilled marksman who can hit the exact target while keeping everything else safe around it.

What is intraoperative radiation therapy?

IORT combines surgery and radiation therapy into a single, coordinated treatment session. During your operation, after the surgeon removes the visible tumor, they deliver radiation directly to the tumor bed or remaining cancer cells.

The radiation beam targets the exact area where cancer cells are most likely to return. Because healthy organs and tissues are temporarily moved out of the way during surgery, your medical team can use higher radiation doses than would be safe with traditional external radiation therapy.

This approach is particularly valuable for cancers that tend to recur locally, meaning they come back in the same area where they first developed. Your surgical team can address both the tumor removal and radiation treatment while you're under anesthesia, potentially reducing your overall treatment time.

Why is intraoperative radiation therapy done?

IORT helps improve cancer treatment outcomes by targeting microscopic cancer cells that might remain after surgery. Even when surgeons remove all visible tumor tissue, tiny cancer cells can sometimes stay behind, invisible to the naked eye.

Your oncologist might recommend IORT if you have certain types of breast cancer, colorectal cancer, sarcomas, or other solid tumors where local recurrence is a concern. It's especially helpful when the tumor is located near critical organs or structures that would be difficult to protect during conventional radiation therapy.

The treatment can also benefit patients who have limited options for external radiation therapy. Some people may have already received maximum safe doses of radiation to an area, making IORT a valuable alternative for addressing new or recurrent cancer in the same region.

For certain early-stage breast cancers, IORT might even replace the need for weeks of daily external radiation treatments. This can significantly reduce your treatment burden and help you return to your normal activities sooner.

What is the procedure for intraoperative radiation therapy?

IORT takes place in a specially equipped operating room that contains both surgical facilities and radiation equipment. Your procedure will involve a coordinated team of surgeons, radiation oncologists, medical physicists, and specialized nurses.

The process begins like a standard cancer surgery, with you under general anesthesia. Your surgeon will first remove the tumor and any affected lymph nodes or tissues as planned. Once the surgical removal is complete, they'll prepare the area for radiation delivery.

Here's what happens during the radiation portion of your procedure:

Your medical team will carefully position a radiation applicator directly against or into the tumor bed. This device delivers the radiation in a very controlled, focused manner. Healthy organs and tissues near the treatment area are gently moved aside or protected with special shields.

The actual radiation delivery typically takes between 10 to 45 minutes, depending on your specific treatment plan. During this time, most staff members will step out of the operating room while the radiation is delivered, though you'll be continuously monitored.

After the radiation treatment is complete, your surgeon will finish the operation by closing the surgical site. The entire procedure usually takes 2 to 6 hours, depending on the complexity of your surgery and the specific type of cancer being treated.

How to prepare for your intraoperative radiation therapy?

Preparation for IORT is similar to preparing for major surgery, with some additional considerations. Your medical team will provide specific instructions based on your individual situation and the type of surgery you're having.

You'll typically need to stop eating and drinking for 8 to 12 hours before your procedure. Your doctor may also ask you to temporarily stop certain medications, especially blood thinners, to reduce bleeding risk during surgery.

Before your treatment day, you'll likely have several preparatory appointments. These might include blood tests, imaging studies, and consultations with your surgical team and radiation oncologist. These visits help ensure everything is perfectly planned for your specific case.

It's important to arrange for someone to drive you home after your procedure and stay with you for the first 24 hours. You'll also want to prepare your home for recovery, including having comfortable clothing, easy-to-prepare meals, and any prescribed medications ready.

Your medical team will discuss any specific preparation steps based on your type of cancer and overall health. Don't hesitate to ask questions about what to expect or voice any concerns you might have.

How to understand your intraoperative radiation therapy results?

IORT results aren't immediately measurable like a blood test or imaging study. Instead, the success of your treatment is evaluated over time through regular follow-up appointments and monitoring.

Your radiation oncologist will measure the treatment success by tracking whether cancer returns in the treated area. This is typically assessed through regular physical examinations, imaging studies like CT scans or MRIs, and sometimes blood tests for tumor markers.

The immediate post-treatment period focuses on surgical healing rather than radiation effects. Your surgical team will monitor your incision healing, pain levels, and overall recovery. Most people experience typical surgical recovery symptoms rather than traditional radiation side effects.

Long-term success is measured by local control rates, which means how well the treatment prevents cancer from returning in the same area. Studies show that IORT can significantly improve local control rates for many types of cancer, often matching or exceeding the effectiveness of traditional external radiation therapy.

Your follow-up schedule will be tailored to your specific situation, but typically includes appointments every 3 to 6 months for the first few years, then annually. Your medical team will explain what to watch for and when to contact them with concerns.

What are the benefits of intraoperative radiation therapy?

IORT offers several significant advantages over traditional external radiation therapy. The most important benefit is the ability to deliver higher radiation doses directly to cancer cells while protecting healthy surrounding tissues.

You'll likely experience fewer side effects compared to external radiation therapy. Since the radiation is delivered internally and healthy tissues are protected during treatment, you're less likely to experience skin irritation, fatigue, or damage to nearby organs.

The convenience factor is substantial for many patients. Instead of daily radiation treatments for several weeks, you receive your radiation therapy during the same procedure as your surgery. This can significantly reduce your treatment burden and help you return to normal activities sooner.

For certain cancers, IORT can improve treatment outcomes. Studies have shown excellent local control rates, meaning the cancer is less likely to return in the treated area. This is particularly true for early-stage breast cancer and certain types of colorectal cancer.

The precision of IORT also allows treatment of cancers in challenging locations. When tumors are near critical structures like the spinal cord, major blood vessels, or vital organs, IORT can deliver effective treatment while minimizing risk to these important areas.

What are the possible complications of intraoperative radiation therapy?

Like any medical procedure, IORT carries some risks, though serious complications are relatively uncommon. Most people experience manageable side effects that resolve with time and proper care.

Common short-term effects are primarily related to the surgery itself rather than the radiation. These might include typical surgical risks like bleeding, infection, or reactions to anesthesia. Your surgical team will monitor you closely for these standard post-operative concerns.

Here are the more common radiation-related effects you might experience:

Tissue changes in the treated area can occur over time. Some people develop firmness, thickening, or changes in skin texture where the radiation was delivered. These changes typically develop gradually over months and are often mild.

Wound healing might be slightly slower in some cases. The radiation can affect how quickly tissues repair themselves, though this usually doesn't cause significant problems when you follow your post-operative care instructions carefully.

Rare but more serious complications can include damage to nearby organs or structures. However, the careful planning and real-time visualization during IORT significantly reduces this risk compared to external radiation therapy.

Some people experience chronic pain or numbness in the treated area. This is more common with certain types of procedures and locations, and your medical team will discuss this specific risk based on your individual case.

Long-term effects, while uncommon, can include the development of secondary cancers in the treated area. This risk is generally lower with IORT compared to traditional radiation therapy due to the precise targeting and single-dose approach.

When should I see a doctor about intraoperative radiation therapy?

You should contact your medical team immediately if you experience signs of serious complications after your IORT procedure. These might include severe pain that doesn't improve with prescribed medications, signs of infection like fever or unusual discharge, or any sudden changes in your surgical site.

During your recovery, watch for symptoms that might indicate complications. Excessive swelling, persistent bleeding, or drainage from your incision site warrants prompt medical attention. Your surgical team will provide specific guidelines about what's normal and what requires immediate care.

For ongoing monitoring, maintain all your scheduled follow-up appointments even if you feel fine. Regular check-ups allow your medical team to detect any issues early and ensure your treatment is working as expected.

Contact your doctor if you notice any new lumps, bumps, or changes in the treated area during your recovery and beyond. While most changes are normal healing responses, your medical team can determine whether further evaluation is needed.

Don't hesitate to reach out with questions or concerns about your recovery. Your medical team expects and welcomes your questions, and addressing concerns early often prevents minor issues from becoming larger problems.