Intraoperative Radiation Therapy (IORT)

Intraoperative radiation therapy is a single, concentrated dose of radiation delivered directly to a tumor bed while the patient is still on the operating table, immediately after the surgeon removes visible cancer. Because healthy organs can be physically moved aside or shielded during surgery, IORT can target microscopic disease left behind without irradiating as much surrounding tissue as conventional external-beam radiation.

Origin

The technique was pioneered in Japan in the 1960s by Dr. Mitsuyuki Abe at Kyoto University, who used orthovoltage x-rays during abdominal cancer surgery. Modern IORT, using mobile linear accelerators or electron applicators in the operating room, became more widely adopted in the 1980s and 1990s.

Significance in Asbestos Context

For pleural mesothelioma patients undergoing aggressive surgery such as pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP), the surgeon cannot remove every microscopic cancer cell from the chest wall, diaphragm, and mediastinum. IORT is one strategy used at select specialty centers to treat that surgical bed during the operation, often combined with chemotherapy and sometimes followed by additional external-beam radiation. Patients considering surgery should ask whether their treating center offers IORT or intensity-modulated radiation therapy (IMRT) as part of a multimodal plan, because not every thoracic surgery program is equipped to deliver it.

Example Sentence

"During her pleurectomy at a mesothelioma specialty center, the surgical team delivered intraoperative radiation therapy to the chest wall to reduce the chance of local recurrence."

Related Terms

Pleurectomy/Decortication, Extrapleural Pneumonectomy, Multimodal Therapy, External Beam Radiation Therapy, Mesothelioma, Adjuvant Therapy

Notes

• Ask your thoracic surgeon and radiation oncologist whether IORT is part of the proposed surgical plan, what dose will be delivered, and which areas of the chest will be targeted.
• IORT is offered at a limited number of mesothelioma specialty centers; if your local hospital does not provide it, request a referral or second opinion at a high-volume center.
• Keep copies of the operative report, radiation treatment summary (including dose in Gray and treatment fields), and pathology report. These records document the intensity of treatment and may matter for both ongoing medical care and any legal claim.
• IORT is generally used as part of a multimodal approach; ask how it fits with chemotherapy, immunotherapy, and any planned post-operative radiation.