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

1. The patient is brought into the operating room and administered general anesthesia.
2. The surgical team performs the tumor removal.
3. Once the tumor is removed, a specialized radiation applicator is positioned at the surgical site.
4. A concentrated dose of radiation is delivered directly to the targeted area.
5. 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.