Intraoperative Radiotherapy

Intraoperative radiation therapy (IORT) is a form of precise and impactful radiation therapy. IORT refers to a single shot of high dose radiation therapy given to the tumour bed (area of cancer) during cancer surgery.

  • There are several case scenarios where IORT finds it’s great advantage.
  • There is only one way to find its appropriate use and that is discussion within team of oncologists.
  • IORT improves the chances of local control of cancer many fold with least side effects.

Sharing two cases where we used HDR brachytherapy based IORT.

Case 1 – Recurrent and previously radiated cancer rectum.

50 years old gentleman with a history of renal transplant and multiple co morbidities developed low rectal adenocarcinoma which was initially treated with pre-operative chemo radiation therapy (CTRT). The patient was planned for surgery post chemo-radiation, however he defaulted the same. One year later the patient presented with local recurrence in rectum infiltrating in adjacent prostate gland. He was treated with neo adjuvant chemotherapy and low dose CTRT with partial response. He then underwent surgery (Abdomino Perineal resection) by a team of surgical oncologist with IORT to tumour bed at prostate. IORT was done using HDR Brachytherapy to the dose of 10Gy single fraction to prostate bed. After 18 months of treatment patient is free of disease and has no major adverse effects.

 

Case 2 – Locally Extensive Carcinoma Buccal Mucosa

52 years old gentleman presented with buccal alveolar cancer with extension to infra temporal fossa. He was initially treated with neoadjuvant chemotherapy (NACT) with partial response. Intraoperatively disease was infiltrating into pterygoid plates. After tumour resection by surgical oncology team, we did IORT using HDR brachytherapy to a dose of 12Gy in single fraction. After 4 weeks from surgery, patient underwent additional post-operative radiation therapy 60Gy/30 fractions with IM IGRT technique. After 18 months of treatment patient is free of disease and has no major adverse effects.

 

Take Home Message – Intraoperative RT is an effective form of radiation therapy especially in challenging circumstances. There are very few institutions across globe where IORT is being practiced and there is a strong case to appropriately use it.