![]() ![]() IORT is most often performed at the time of breast surgery as a single dose, while other APBI techniques are performed post-operatively, using target volumes are typically based on CT images and delivering multiple fractions. The major difference between IORT techniques and other forms of APBI is timing of the procedure. Intraoperative radiotherapy (IORT) is one such technique. There are several techniques which have been studied to accomplish irradiation of the periphery of the lumpectomy bed as sole therapy after lumpectomy, which is the target volume for any form of partial breast treatment. Partial breast irradiation has been established as a suitable treatment option for appropriately selected women with early stage breast cancer by numerous clinical trials dating back to the 1990s. ![]() Ongoing international clinical trials are studying these uses and follow-up data are accumulating on completed studies. It may also be very useful in specific situations, such as prior to oncoplastic reconstruction to improve accuracy of adjuvant radiation delivery, or when used as a boost in higher risk patients to improve tumor control. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses. However, IORT as a tumor bed boost has also been studied and appears to be safe with acceptable toxicity. When unexpected findings on final pathology such as positive margins or positive sentinel nodes predict a higher risk of local or regional recurrence, additional whole breast radiation may be indicated, thereby reducing some of the convenience and low-toxicity advantages of sole IORT. The main disadvantage of IORT is the lack of final pathologic information on the tumor size, histology, margins, and nodal status. The advantages of IORT for partial breast irradiation include: direct visualization of the target tissue ensuring treatment of the high-risk tissue and eliminating the risk of marginal miss the use of a single dose coordinated with the necessary surgical excision thereby reducing omission of radiation and the selection of mastectomy for women without access to a radiotherapy facility or unable to undergo several weeks of daily radiation favorable toxicity profiles patient convenience and cost savings radiobiological and tumor microenvironment conditions which lead to enhanced tumor control. There are two large prospective randomized trials establishing the safety and efficacy of breast IORT in early stage breast cancer patients with sufficient follow-up time on thousands of women. Regardless of technique, IORT generally refers to the delivery of a single dose of radiation to the periphery of the tumor bed in the immediate intraoperative time frame, although some protocols have performed IORT as a second procedure. There are several technologies in clinical use to perform breast IORT. Intraoperative radiotherapy (IORT) for early stage breast cancer is a technique for partial breast irradiation. 2Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Chicago, IL, United States.1Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, United States. ![]()
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