What Is Intraoperative Radiation Therapy (IORT) for Breast Cancer?

Question: What Is Intraoperative Radiation Therapy (IORT) for Breast Cancer?

After a lumpectomy, you may need to have radiation treatments to reduce your risk of recurrence. You may offered a six-week course of external beam radiation, or brachytherapy (internal radiation) for a five-day course. Surgeons and radiation oncologists in the United States may someday have an even faster method of radiation to offer. It's called Intraoperative Radiation Therapy (IORT), and is done right in the operating room.

Answer: About Intraoperative Radiation Therapy for Breast Cancer
Intraoperative radiation therapy is a technique that delivers your radiation treatment while you are still in surgery. Your radiation dose is aimed directly at your exposed tumor bed, while surrounding healthy tissue is moved aside. The entire dose of radiation that is needed will be given in one treatment, which may take from two to 30 minutes. This technology is being used in Europe and Asia, and is in clinical trials in the United States. Intraoperative radiation therapy is sometimes referred to as Intraoperative Electron Radiation Therapy (IOERT).

You're A Good Candidate for Breast IORT If –
Patients who participated in trials of breast IORT had low-grade, early-stage breast cancer, with no lymph node involvement and clear surgical margins from a lumptectomy. Most participants were women 40 years and older.

Advantages of Intraoperative Radiation Therapy

• Only one radiation treatment needed
• Less patient travel, fewer appointments
• Fewer side effects
• No skin affected by treatment
• Better cosmetic results
• Immediate reconstruction can be done right away
• Adjuvant chemotherapy can be scheduled without conflict
• Faster recovery
• May save cost of treatment

Disadvantages of Intraoperative Radiation Therapy

• Workflow during surgery must be carefully coordinated between surgeons and radiation oncologists
• Small risk of infection
• Difficult to monitor dosage to the radiation site
• Few patients may have access to this technology
• Not yet enough evidence of long-term results

Possible Complications of Breast IORT
No combination of surgery and radiation treatments are perfect. In one study of 921 patients who had breast IORT, complications did occur in a small percent of patients. Those complications included: fat necrosis (4.2%), hematoma (1.3%), and mild fibrosis (2.6%). The local cancer recurrence rate was 1.6%.

Other Cancers May Benefit from IORT
Breast cancer is only one type of cancer that may be treated with intraoperative radiation therapy. Research is being done on using IORT to treat other cancers: rectal, head and neck, pancreatic, prostate, soft tissue sarcomas.

Some Types of IORT Devices

• IntraBeam System (Carl Zeiss Surgical, Oberkochen, Germany)
• Mobetron System (Intraop Medical Corporation, Sunnyvale, CA)

_Sources:

Contemporary Surgery, Vol. 64, No. 5, May 2008. Partial-breast irradiation: Rating today’s evidence. Amy C. Degnim, MD, Judy C. Boughey, MD, Nicole Sookhan, MD.

Tumori. 2005 Jul-Aug;91(4):339-45. Intraoperative radiotherapy (IORT) for breast cancer using the Intrabeam system. Kraus-Tiefenbacher U, Scheda A, Steil V, Hermann B, Kehrer T, Bauer L, Melchert F, Wenz F.