Breast Cancer: Intraoperative Radiation Therapy (IORT)

Developments in medical technologies not only find a remedy for incurable diseases but also bring along comfortable solutions facilitating the processes of treatments which have been deemed challenging in the past. Especially in treatments of breast cancer. For example, removal of the entire breast tissue is not currently necessary for treatment of breast cancer; the cancerous zone can solely be removed surgically, thus the remaining tissue can be spared. Besides, several treatment options including intraoperative radiotherapy (IORT) and/or external radiotherapy are offered to the patients in the postoperative period thanks to advanced medical technologies. For breast cancer, unlike the external radiotherapy, intraoperative radiation therapy (IORT) is performed to deliver the radiation beams directly to the location of tumor rather than the entire breast. Thus, radiation can be given in a single dose, translating into fewer side-effects comparing to external radiotherapy. Moreover, the procedure targets only the cancerous region.

What is Intraoperative Radiation Therapy (IORT)?

Intraoperative Radiation Therapy (IORT) implies irradiating the tumor bed where the tumor is excised using special devices during lumpectomy (removal of a part of the breast due to cancer). Being preferred for early stage breast cancer, this treatment works in a different way than the radiation therapy applied to the entire breast (external beam radiation therapy – EBRT). Intraoperative radiotherapy can be combined with external radiotherapy or chemotherapy, when necessary.

Comparing to other practices, major advantages of IORT are as follows:
  • The procedure lasts shorter.
  • It can be performed in a single dose rather than daily sessions for several weeks.
  • It is associated with fewer side effects than EBRT.
  • It ensures irradiating the tumor zone at higher dose.
  • It is confined to the tumor bed, where the tumor is excised, and thus, it spares healthy tissues.
IORT is performed during the surgery and it takes half an hour at most. Its major advantage relative to standard postoperative treatment modalities, which may last for several weeks, is the lack of necessity to visit a radiotherapy center after the treatment. Because; it ensures that the preventive radiotherapy is completed on the day of surgery.

Which stage of breast cancer is suitable for Intraoperative Radiation therapy?

If you are older than 50 and have early stage breast cancer, your chance to benefit from IORT is much higher.

How frequently is Intraoperative Radiation therapy performed?

IORT requires special equipment, which is not available in all healthcare institutions. Therefore, it is used quite rarer than external radiotherapy and can be performed under special circumstances.

How is Intraoperative Radiation Therapy performed to treat breast cancer?

IORT is used for patients, who undergo lumpectomy (removal of tumor from breast tissue) and who are not eligible for mastectomy (removal of entire breast) for treatment of breast cancer. IORT device delivers low-energy, high-dose radiation directly on the tumor bed (the space caused by removal of the tumor from the breast tissue) in the operating room, after the tumor is surgically removed.
Following lumpectomy, spherical applicator of the IORT device is directly placed into the tumor bed and the applicator irradiates the target zone at doses lower than that of the radiation therapy.

How are patients prepared for Intraoperative Radiation Therapy?

The radiation oncologist determines the appropriate radiation dose and correct angle for radiation beams on the day of surgery and informs you before the surgery. You do not feel or see anything during this procedure as you are anesthetized for surgery.

How is the procedure performed?

First, the tumor is surgically excised before radiotherapy. Next, IORT is applied to the location of the tumor with low-energy KV beams. No other organ than the targeted disease bed is exposed to radiation during radiotherapy. Following the radiation therapy lasting for half an hour, the surgery is completed as planned.

How long does the procedure take?

IORT therapy is generally completed in approximately 30 minutes depending on the IORT device.

Will I be anesthetized during intraoperative radiation therapy?

Yes, you will be under anesthesia.

What should I expect after the procedure?

Since you will not emit radiation after the procedure, routine surgery process should be expected. Be sure that you rest sufficiently, take adequate amount of fluids and eat nutritious meals after the procedure.

What are the advantages of Intraoperative Radiation Therapy?

There are numerous advantages of intraoperative radiotherapy performed for the breast:
All required radiation doses are delivered at once. “Standard” radiotherapy program for breast cancer is applied 5 days a week for up to 6 weeks. IORT saves time and it is efficient and practical for the patient.
The radiation dose delivered in IORT is far lower than the dose of external beam radiotherapy.
If there are intact/healthy organs and tissues near the target area, the IORT ensures that they are exposed to far lower radiation.

If another tumor is detected in the breast in the future and it is deemed necessary, tumor can solely be excised without removing the breast. (total removal of the breast may be necessary in external radiotherapy.)
Cost of IORT is substantially lower than external beam radiotherapy.

Is Intraoperative Radiation therapy a painful procedure?

Procedure will cause no harm at all. Painful bruises may develop in the target area after the procedure.

What is prognosis? How effective is Intraoperative Radiation therapy?

Studies have shown that Intraoperative Radiation therapy is as effective as external radiotherapy. If a different condition is noted in the pathology report, it is necessary to perform external radiotherapy (EBRT) in addition to Intraoperative Radiation therapy (one out of every 7 patients). Considering the risk of local recurrence (cancer recurring in the same breast), the rate of recurrence is 2.1 percent for IORT while it is 1 percent for EBRT.