What is intraoperative radiotherapy (IORT)?

IORT delivers a single dose of high-energy radiation directly to the tumour bed during surgery, once the tumour has been removed. It makes it possible to treat precisely the area at highest risk of recurrence while the surrounding healthy organs are physically moved aside, reducing their exposure to radiation.

Conventional radiotherapy is given in fractions over 5-6 weeks after surgery. IORT delivers, in a single intraoperative session, a dose equivalent to several weeks of external treatment, with greater precision and less exposure of the surrounding healthy tissue.

Its main indications are rectal cancer after resections with close margins, retroperitoneal sarcomas to improve local control, pancreatic cancer in borderline resections and pelvic recurrence of colorectal or gynaecological tumours. In each case the indication is decided by a multidisciplinary committee.

IORT reduces local recurrence, is given in a single session built into the operation, protects the adjacent healthy organs and lowers toxicity compared with fractionated external radiotherapy. This means less impact on the patient's quality of life during treatment.

Once the tumour has been resected, the surgeon and the radiation oncologist apply radiation directly to the tumour bed inside the operating theatre. Healthy organs are physically shielded or moved out of the irradiation field. The procedure adds little time to the main operation.

Yes. In some protocols, IORT is combined with postoperative external radiotherapy to improve local control. Joint planning by the surgeon and the radiation oncologist determines the total doses and the order of administration according to the type of tumour and the margins obtained.

IORT requires specialised equipment inside the operating theatre and close coordination between the oncological surgery and radiotherapy teams. That is why it is only offered by centres that have this equipment and teams trained to use it.

The risks are lower than with conventional external radiotherapy, thanks to the direct protection of healthy organs during irradiation. The most relevant effects depend on the area treated and are assessed individually according to the location of the tumour and the adjacent tissues.

In retroperitoneal sarcomas and pelvic recurrence, an improvement in local disease control has been described when IORT is added. The impact on overall survival depends on the type of tumour, the stage and how complete the associated surgical resection is.

Candidacy is decided by a multidisciplinary committee, taking into account the type of tumour, its location, the expected resection margins and the patient's general condition. Our team assesses each case to decide whether IORT offers a real benefit.