IORT in the Management of Locally Advanced or Recurrent Head and Neck Cancer

Perioperative high-dose-rate brachytherapy (PHDRB) in previously irradiated head and neck cancer: Initial results of a Phase I/II reirradiation study

“…Some advantages of PHDRB compared to IOERT and intraoperative high-dose-rate brachytherapy (25)(26)(27)35) are as follows: (1) use of computerized axial tomography (CT) scan-based treatment planning and optimization, (2) determination of the brachytherapy dose based upon the amount of residual disease as described in the final pathology report, and (3) fractionation-improved therapeutic ratio. In addition, PHDRB treats a smaller tissue volume than does EBRT (22)(23)(24) and, therefore, severe late toxicity could be minimized due to the dose-volume effect.…”

Intraoperative Radiotherapy (IORT) with Low-Energy Photons as a Boost in Patients with Early-Stage Oral Cancer with the Indications for Postoperative Radiotherapy

“…Some authors described its utility in a combined, primary, radical treatment of usually locally advanced, high-risk or recurrent HNC. Addition of eIORT to resection and its combination with postoperative EBRT seems to improve local control in this group of patients [5,17,19,27]. Other studies report the palliative role of eIORT for HNC.…”

“…In this group of patients, similarly to more advanced cases, postoperative external-beam radiotherapy (EBRT) is often employed with escalated dose to the tumor bed (boost) [1,13,18,20,25,30]. There are different techniques of boost delivery [5,8,9,11,16,17,21,24,26,33] and intraoperative radiation therapy (IORT) is one of them. This treatment option -particularly due to substantial advantages over others -could be beneficial for such patients.…”

“…This method allows precise application of a high radiation dose to the target area immediately after tumor excision with a minimal exposure of surrounding normal tissue. Most clinical experiences of IORT are based on electron beam (eIORT) produced by linear accelerator [5,17,19,21,26,27] or high-energy photons (brachytherapy) [11].…”

Recurrent salivary gland carcinomas treated by surgery with or without intraoperative radiation therapy

“…Based on this experience, our current policy is to recommend IORT for essentially all patients with locally recurrent salivary gland carcinomas treated by surgical resection. Although we were unable to assess the role of additional postsalvage external‐beam radiation due to small patient numbers, others have shown that this may improve outcomes in carefully selected patients after IORT 32. Clearly, much work needs to be done to define optimal therapy after local recurrence from salivary gland carcinoma.…”