Intraoperative radiation therapy

EMC is one of the few clinics where the innovative technique of intraoperative radiation therapy (IORT) is used. The essence of the technique is to apply high-dose ionizing radiation during surgical treatment to the place where the tumor was located, as well as to the risk areas for recurrence. The advantage of IORT is the ability to deliver the required dose of radiation to the tumor with maximum accuracy and in a narrowly targeted manner, while the adjacent organs and tissues are not exposed to radiation, therefore reducing the possibility of radiation reactions.

The purpose of IORT is to minimize the risk of recurrence by destroying tumor cells that may be left at the edges of the surgical wound.

Despite the fact that the IORT system is easy to move and install in the operating room, this technique is difficult to carry out. Its implementation requires the coordinated actions of specialists: a surgeon, an anesthesiologist, a radiologist, a physicist, a dosimetrist, and nurses. The treatment is performed using a probe that is inserted directly into the surgical field.

When using radiation therapy immediately after surgical treatment, healing of the postoperative wound may slow down, due to this, it is recommended to start it approximately 30 days after surgical treatment, therefore the risk of recurrence increases. IORT is used directly during surgical treatment, reducing the risk of recurrence by directly affecting tumor cells in the surgical wound.

IORT has the most precise effect on the area where the neoplasm was located in the surgical wound, minimizing the effect of ionizing radiation on surrounding tissues not involved in the tumor process.

Breast cancer is the main disease in which IORT is used. Organ-preserving surgical treatment of breast cancer with preservation of breast structure is widely used in EMC. Accordingly, in order to reduce the risk of incomplete tumor removal, the use of IORT is optimal. The use of IORT has also shown good efficacy in glioblastomas.

After removal of the neoplasm, a spherical balloon applicator is inserted into the postoperative cavity and an ionizing radiation source is connected. After applying the required dose of ionizing radiation, the applicator is removed and the surgical wound is sutured. The duration of the procedure, as a rule, does not exceed 30 minutes. During this procedure, patients are under general anesthesia, thus, the occurrence of pain in patients is excluded. It should be noted that patients in the postoperative period are observed in the same way as patients without IORT, and the risk of additional complications from the treatment is minimal.

It is important to note that the use of the IORT technique does not exclude the possible use of traditional radiation therapy if appropriate indications are available.