Intraoperative radiation treatment management
CPT4 code
Name of the Procedure:
Intraoperative Radiation Treatment Management (IORT)
Summary
Intraoperative Radiation Treatment Management (IORT) is a procedure where a concentrated dose of radiation is delivered directly to a targeted area during surgery. This approach minimizes exposure to surrounding healthy tissues and allows for immediate treatment of residual cancer cells post-tumor removal.
Purpose
IORT is primarily used to treat certain types of cancers. The goals are to eliminate remaining cancerous cells after surgical removal of a tumor, reduce the likelihood of cancer recurrence, and enhance the effectiveness of other cancer treatments.
Indications
- Patients with local or regionally advanced cancers where precise radiation targeting is beneficial.
- Cancers that are difficult to remove completely through surgery alone.
- Suitable for patients undergoing surgical tumor removal where immediate radiation can be advantageous.
Preparation
- Patients may need to fast for a specified time before surgery.
- Medication adjustments, especially blood thinners, may be required.
- Preoperative imaging and diagnostic tests to assess the tumor and surrounding tissues.
Procedure Description
- The patient is brought into the operating room and administered general anesthesia.
- The surgical team performs the tumor removal.
- Once the tumor is removed, a specialized radiation applicator is positioned at the surgical site.
- A concentrated dose of radiation is delivered directly to the targeted area.
- The applicator is removed, and the surgery is completed.
Tools involved:
- Radiation delivery devices, such as linear accelerators.
- Radiation shielding equipment to protect surrounding tissues.
Anesthesia:
- General anesthesia is typically used.
Duration
The entire procedure, including both surgery and radiation treatment, can take several hours.
Setting
Performed in a hospital's operating room equipped with specialized radiation delivery equipment.
Personnel
- Surgeons specialized in oncology.
- Radiation oncologists.
- Operating room nurses.
- Anesthesiologists.
- Medical physicists to calibrate and deliver the radiation dose.
Risks and Complications
- Common: Skin irritation, fatigue, localized pain.
Rare: Infection, bleeding, unexpected damage to surrounding organs or tissues.
Management of complications may require additional medical treatment or interventions.
Benefits
- Direct targeting of residual cancer cells, minimizing risk to healthy tissues.
- Reduced need for postoperative radiation therapy.
- Immediate treatment leads to better local control of the disease. Benefits are typically realized shortly after recovery from surgery.
Recovery
- Postoperative care includes wound management, pain control, and monitoring for any signs of complications.
- Recovery time varies but generally spans several weeks.
- Follow-up appointments are crucial to monitor progress and manage any side effects.
Alternatives
- Standard external beam radiation therapy, administered over several weeks.
- Systemic therapies like chemotherapy.
- Pros: Non-invasive options are available for those who cannot undergo surgery.
- Cons: May not offer the same level of localized control as IORT.
Patient Experience
During the procedure:
- Patients are under general anesthesia and will not feel anything.
After the procedure:
- Patients may experience pain at the surgical site, managed with medications.
- Advised to engage in limited physical activities until fully recovered.
- Detailed care instructions provided to support recovery and manage side effects.