Learning the IORT Mechanism, Potential Advantages in Cancer Surgery

CancerNetwork^® spoke with Natalie A. Lockney, MD, and Kamran Idrees, MD, MSCI, MMHC, FACS, about the mechanism of intraoperative radiation therapy (IORT) as well as the potential advantages it may offer to patients with cancer compared with standard radiation treatments.

Lockney, an assistant professor in Radiation Oncology and the program director for the radiation oncology medical residency at Vanderbilt University Medical Center, stated that IORT may be applicable across several patient populations. According to Lockney, IORT has previously demonstrated utility in pancreatic cancer, sarcoma, and rectal cancer, among other types.

Idrees is the chief of the Division of Surgical Oncology & Endocrine Surgery, an associate professor of Surgery, an Ingram Associate Professor of Cancer Research, and director of Pancreatic and Gastro-Intestinal Surgical Oncology at Vanderbilt University Medical Center.

Transcript:

Lockney:

Intraoperative radiation therapy, IORT, is a form of radiation that is delivered intraoperatively as a 1-time dose. After the surgeon resects the tumor, the surgeon and radiation oncologist identify the area at risk, or the positive margin, and insert an applicator into the tumor bed to deliver the radiation therapy.

The key benefits of delivering IORT while in the operating room are No. 1: The surgeon and radiation oncologist can visualize the area at risk in real-time together. No. 2: Critical nearby structures such as the small bowel, stomach, etc., can be manually retracted away from the radiotherapy field to safely allow delivery of higher doses of radiation therapy than possible with standard external beam radiation approaches. Another additional advantage is patient convenience because the radiation is delivered while they’re under anesthesia, which can be particularly helpful for patients who may live long distances from a radiation center.

Idrees:

What tumors would benefit from interoperable radiation therapy?

Lockney:

IORT has been used for many different cancer types. We will focus on pancreatic cancer. However, it’s also commonly used for rectal cancer, some sarcomas, head and neck cancer, and gynecological malignancies.