The Institut Mèdic Onco-Radioteràpia (IMOR), a center specialized in oncology patient care, was a pioneer in performing intraoperative radiotherapy treatments in Spain in 2014. Two years later, they perform 100 such treatments a year, two per week. The radiation oncologist Dr. Ferran Guedea Edo and the medical director of the IMOR Foundation, Dr. Benjamín Guix Melcior, explain to us what this innovative cancer treatment consists of.
What is intraoperative radiotherapy?
Dr. Guix: Intraoperative radiotherapy is a type of procedure used in the operating room. It consists of administering the treatment at the same time as the operation, that is, when the patient undergoes surgery to remove the tumor. Right in the area where the tumor was located, there is a cavity known as the “tumor bed” or “surgical bed”; it is in this area where tumor cells are most likely to remain.
How is it applied?
Dr. Guedea: To perform this treatment, a state-of-the-art operating room is necessary, but above all a small accelerator that can be moved in all directions with minimal effort and that allows the radiation to be coupled to the indicated area. The head can be moved easily with one hand. This head with a cone or cylinder is placed inside the tumor bed and a dose of radiation is applied to destroy these microscopic cells that are not visible to the naked eye. The session lasts 20 minutes, which means that the surgical procedure takes approximately 30 minutes.
What are the advantages?
Dr. Guedea: The main advantage of intraoperative radiotherapy is that it makes it possible to treat the area where the tumor was located with great precision. To administer it, all the organs that are close to the affected area are removed, which prevents proliferation and reduces side effects.
Dr. Guix: Another advantage is that it shortens the duration of treatment, since in many cases a single session at the time of the operation is sufficient, thus avoiding the need to administer external radiotherapy.
Can it be used in any cancer, and which patients are candidates?
Dr. Guix: It is applied mainly in cases of breast cancer, although it is also used in some cases of cancer of the abdominal cavity, rectum, pancreatic head, stomach and liver.
Dr. Guedea: It is used in tumors with a very good prognosis, small, well localized and without affected lymph nodes. When the tumor is not so small or there are affected lymph nodes, it is necessary to complete the treatment with external radiotherapy.
Why is a multidisciplinary team required to perform this technique?
Dr. Guix: It is a treatment that cannot be performed by an oncologist alone, but requires the collaboration of a multidisciplinary team. First of all, a radiodiagnostic team delimits the area in which the tumor is to be removed. The surgeon then operates on the patient and removes the tumor. Then, using intraoperative radiotherapy, the radiation oncologist assigns the dose of radiotherapy to be administered and studies which adjacent structures, such as nerves or blood vessels, need to be protected. Finally, the physicist ensures that the treatment is carried out according to the oncologist’s prescription.
Dr. Guedea: The decision to do this treatment varies depending on many factors and has to be decided with different specialists.