Following a cancer diagnosis, the two major steps that typically follow are surgical tumor removal and radiation therapy. In most standard cancer treatments, surgery and radiation are done separately. A surgical oncologist removes the tumor and then, after recovery from surgery (and chemotherapy if needed), daily outpatient radiation begins, lasting weeks or even months.
Due to side effects and the logistical burden of a daily, intensive radiation treatment schedule, traditional radiation therapy can be both emotionally and physically challenging.
However, for the right candidates, an advanced technique called Intraoperative Radiation Therapy (IORT) can mean fewer hospital visits, less disruption to daily life, and a faster path to recovery, all while achieving comparable outcomes to traditional radiation therapy.
Modern, minimally invasive surgery options are life-changing for many cancer patients. IORT takes that a step further. IORT combines cancer surgery and radiation into a single procedure. With IORT, radiation is delivered during surgery immediately after the tumor is removed, eliminating the need for weeks of follow-up radiation appointments.
In this article, the expert surgical oncology team at The Surgical Clinic in Nashville explains everything you need to know about IORT, including:
- What Intraoperative Radiation Therapy (IORT) is and how it works
- How IORT compares to traditional External Beam Radiation Therapy (EBRT)
- How the IORT procedure works, step by step
- The benefits of combining surgery and radiation in a single session with IORT
- Types of cancer IORT can treat, and who is a good candidate for IORT
- Potential side effects and risks of IORT
- Success rates of IORT
- Where to find IORT in Middle Tennessee
What is Intraoperative Radiation Therapy (IORT)?
Intraoperative Radiation Therapy (IORT) is a one-time concentrated dose of radiation delivered directly to the cancerous tumor site during cancer surgery, right after the tumor has been surgically removed.
Unlike traditional radiation therapy, which is administered externally over the course of several weeks after surgery, IORT happens in the operating room while you’re still under anesthesia. When you wake up, both tumor removal and radiation treatment are complete.
The IORT approach is a relatively new advanced cancer treatment technique that allows your surgical oncologist and radiation oncologist to work together to target the exact area where cancer cells are most likely to remain, while healthy tissue and nearby organs are temporarily moved aside or shielded.
They can see exactly where the radiation needs to go. There’s no guesswork involved, and there’s no concern about the tumor bed shifting or changing shape between surgery and radiation, which can sometimes happen with traditional external beam radiation therapy.
Additionally, because surrounding healthy tissue can be protected during the procedure, IORT allows for a higher radiation dose than would typically be safe with external beam radiation therapy. For many patients, this means the entire course of radiation treatment can be completed in one session, eliminating the need for daily radiation appointments that can last weeks or even months.
While IORT isn’t appropriate for every cancer or every patient, for those who qualify, it represents a significant advancement in convenience, precision, and quality of life during cancer treatment.
What Is the Difference Between IORT and Traditional External Beam Radiation Therapy (EBRT)?
Intraoperative Radiation Therapy (IORT) and External Beam Radiation Therapy (EBRT) are both cancer radiation treatments that aim to destroy any remaining cancer cells after surgery and can effectively reduce the risk of cancer recurrence. However, they differ significantly in how, when, and where the radiation is delivered.
- IORT delivers a single, concentrated dose of radiation during surgery, directly to the tumor bed. This approach limits radiation exposure to surrounding tissue and helps minimize side effects such as skin irritation and fatigue. It’s often recommended for early-stage cancers or in cases where the tumor can be completely removed during surgery.
- EBRT uses an external machine to direct radiation toward the treatment area after surgery. While it’s highly effective, EBRT typically requires daily sessions for several weeks and may lead to more skin changes or fatigue because of broader tissue exposure.
The right radiation therapy approach depends on your exact diagnosis, tumor type, and overall treatment plan. For patients with early-stage cancers that meet the criteria for single-dose IORT, it can often provide the same level of cancer control as a full course of daily EBRT, with significantly fewer burdens on the patient.
That said, IORT may not be able to replace EBRT for all patients. Depending on the final pathology results, you may still need additional external beam radiation after IORT. Your oncology team will help you determine which approach is best for your specific situation, taking into account the type of cancer, tumor size, location, and your overall health.
Quick Comparison: IORT vs. EBRT
| Intraoperative Radiation Therapy (IORT) | External Beam Radiation Therapy (EBRT) | |
| Delivery method | Radiation is delivered internally in a single session during surgery. | Radiation is delivered externally using focused beams after surgery. |
| Treatment schedule | Completed in one session while the patient is still under anesthesia in the operating room. | Daily outpatient treatments for weeks to months following surgery. |
| Target area | Directly targets the tumor bed, with healthy tissue temporarily moved aside and more protected. | Covers a broader area, including healthy skin and surrounding tissue. |
| Radiation dose | A single, high dose is applied precisely to the tumor site. | Multiple lower doses are administered over time. |
| Side effects | Less skin irritation and fatigue due to lower exposure to healthy tissue. | More likely to cause redness, fatigue, or changes to nearby skin. |
| Convenience | Very convenient. Typically, one and done during surgery. | Not convenient. Multiple daily trips for ongoing radiation sessions. |
| Recovery | Shorter recovery time and faster return to normal routines. | Longer overall recovery due to extended treatment duration. |
| Cost effectiveness | Often less expensive overall since it reduces the need for weeks of external treatment. | Generally higher total treatment costs because of multiple sessions. |
What are the Benefits of IORT?
ORT is becoming an increasingly popular option for eligible cancer patients who need radiation. One of the most significant advantages of IORT single-session radiation treatment is the convenience it offers cancer patients.
No more daily radiation therapy appointments for weeks at a time. With IORT, radiation is delivered immediately during surgery, directly to the area where the tumor was removed.
But the benefits of IORT extend far beyond convenience. From greater precision and protection for healthy tissue to fewer side effects and even potentially better cosmetic outcomes for certain cancers, such as breast cancer, there are many advantages to this advanced radiation therapy approach.
Why Choose IORT Single-Session Cancer Treatment?
Convenience and Quality of Life
Traditional external beam radiation therapy (EBRT) typically requires daily trips to a radiation center, five days a week, for several weeks or months. For many patients, this schedule is physically exhausting and logistically challenging. It may mean taking time off work, arranging transportation, and managing the cumulative side effects of repeated daily radiation exposure.
With IORT, the entire radiation treatment is completed in a single session during surgery. For most patients, there are no follow-up radiation appointments to schedule, no daily commutes to the hospital, and no prolonged treatment timeline.
This can drastically improve quality of life for cancer patients, especially those who live far from a radiation center or who have demanding work or family responsibilities.
Precision Targeting
Because IORT is delivered directly to the tumor bed while it’s fully exposed during surgery, the radiation can be aimed with the highest level of precision. Healthy tissue and nearby organs are moved out of the way or shielded, which means they receive little to no radiation exposure.
This level of precision is difficult to achieve with external beam radiation, where the radiation must pass through layers of skin and tissue to reach the target area. With IORT, the radiation goes exactly where it needs to go, and nowhere else.
Higher Radiation Dose in a Single Treatment
Traditional radiation therapy uses lower doses of radiation spread out over many sessions to minimize damage to healthy tissue. IORT, on the other hand, can deliver a higher dose in a single treatment because the radiation is applied directly to the tumor bed while healthy structures are protected.
This concentrated dose can be just as effective as weeks of external radiation for certain cancers, particularly early-stage breast cancer, where studies have shown comparable outcomes between IORT and traditional radiation therapy.
Fewer Side Effects
One of the most common side effects of external beam radiation therapy is skin irritation and damage in the treatment area. Because the radiation must pass through the skin to reach the tumor, patients often experience redness, peeling, and discomfort that can last for weeks.
With IORT, the radiation is delivered internally, so there’s no radiation passing through the skin. This significantly reduces the risk of skin-related side effects. Patients also tend to experience less fatigue compared to those undergoing weeks of daily radiation treatments.
Cost-Effectiveness
While the upfront cost of IORT may seem comparable to traditional radiation, the total cost of treatment is often lower. It is difficult to give an exact estimate of cost for IORT, as many factors come into play, such as the surgical center performing the therapy and insurance coverage.
Cost can vary based on many factors, but on average, IORT typically costs between $8,000 and $10,000, while a full course of external beam radiation therapy often exceeds $30,000 when you factor in the cost of multiple weeks of treatment, facility fees, and associated appointments.
Additionally, the time saved by avoiding daily radiation visits can translate to less time away from work and fewer indirect costs related to transportation and caregiving.
Better Cosmetic Outcomes
For breast cancer patients in particular, IORT has been associated with better cosmetic outcomes. Because there’s less radiation exposure to the surrounding breast tissue and skin, patients often experience less scarring, better breast shape retention, and improved overall appearance compared to traditional whole-breast radiation.
Who is a Good Candidate for IORT?
Many cancer patients are potential candidates for Intraoperative Radiation Therapy (IORT), but it’s not the right choice for everyone.
Just like cancer surgery itself, where there are different types that must be tailored to the tumor’s location, stage, and biology, the decision to use IORT instead of traditional radiation therapy depends on several factors, including the type of cancer, the size and location of the tumor, and the patient’s overall health.
Here are the cancer types and scenarios where patients are typically the best candidates for the IORT combination cancer treatment approach.
Types of Cancer Commonly Treated with IORT
- Breast cancer: The most common type of cancer treated with IORT is breast cancer. It’s especially effective for early-stage breast cancer following a lumpectomy, where radiation can be delivered directly to the tumor bed. Research shows IORT offers comparable local control and survival outcomes to traditional external radiation for selected patients, while often resulting in better cosmetic outcomes and fewer side effects.
- Colorectal cancers: Colon cancers, particularly rectal cancers, where the tumor is located in a confined area that can be accessed during surgery, are often treated with IORT. This technique allows physicians to target residual cancer cells that might be difficult to reach with external radiation alone.
- Pancreatic cancer: IORT can be used to deliver a concentrated dose of radiation to any remaining cancer cells in the pancreas or surrounding tissue after tumor removal, helping to reduce local recurrence risk.
- Gynecological cancers: IORT can precisely target radiation to the pelvic area to help protect surrounding organs. Uterine and ovarian cancers are often types of cancers where IORT can be used.
- Thyroid cancer: While IORT isn’t the standard for many thyroid cancer patients, it is considered in select advanced or recurrent cases, and poorly differentiated cases where the cancer is difficult to remove completely or where standard treatments are less effective.
- Sarcomas: Certain soft tissue cancers that occur in the limbs or abdomen may benefit from IORT because it allows high-dose radiation to be administered during surgery while minimizing exposure to nearby healthy tissue.
- Spine and brain tumors: In select cases, IORT can be used for tumors near critical nerves or brain structures, where precision radiation is essential to avoid damage to healthy tissue.
Even if the type of cancer you have can be treated using the IORT technique, your care team will still need to determine whether you meet more specific selection criteria.
To learn more about treatment options for cancer therapy, read “Types of Cancer Treated with Surgical Oncology and Treatment Options.”
What Is the IORT Patient Selection Criteria?
Many types of cancer can be treated using the IORT technique. However, there are still individual factors that determine whether or not you are an ideal candidate for IORT.
Your surgical oncologist and radiation oncologist will consider several factors when deciding if IORT is appropriate for you, including:
- Tumor size: Smaller tumors are generally better suited for IORT, as larger ones may require more extensive radiation coverage than IORT alone can provide.
- Tumor location: The tumor must be in a location that can be safely accessed during surgery and where nearby healthy tissue can be protected.
- Cancer stage: IORT is most effective for early-stage cancers. Advanced cancers that have spread to lymph nodes or distant areas often require a broader radiation approach.
- Overall health: Patients must be healthy enough to undergo surgery and general anesthesia safely.
- Pathology results: In some cases, the final decision about whether IORT alone is sufficient depends on what the pathology report shows after the tumor is removed.
If you’re exploring cancer treatment options, find your surgeon and book a consultation with the expert oncology team at The Surgical Clinic in Nashville. They will be able to tell you if you are a candidate for IORT.
Even if you don’t qualify for IORT alone, you might be able to take a hybrid approach that combines IORT with a shorter course of external beam radiation therapy (EBRT) to help ensure the best possible long-term outcome.
Is IORT Safe?
Like any medical procedure, Intraoperative Radiation Therapy (IORT) comes with potential risks and side effects. Let’s take an honest look at what you should know if you are considering this cancer treatment.
Possible Complications and Side Effects of IORT
IORT is generally well-tolerated. Side effects directly related to IORT itself are often minimal. Most discomfort comes from the tumor removal surgery itself.
Patients may experience typical surgical risks such as.
- Postoperative pain, bleeding, or soreness at the incision site
- Infection or delayed wound healing
- Seroma (fluid buildup under the skin), which may require drainage
While IORT allows radiation to be delivered more precisely than traditional methods, some complications can result from the radiation itself, rather than the surgery. While rare, complications might include:
- Fibrosis (tissue hardening): Scarring or stiffness in the treated area, which can occasionally affect breast appearance after breast cancer surgery
- Neuropathy: Numbness, tingling, or discomfort when radiation is delivered near nerves
- Stenosis: Narrowing of nearby passages such as portions of the intestine or the ureters (tubes that carry urine from the kidneys to the bladder)
- Fistula formation: A rare complication where an abnormal connection forms between nearby tissues or organs
It’s important to remember that these side effects are uncommon and often manageable with proper medical care. For most eligible patients, the benefits of IORT far outweigh these potential risks, particularly when compared to traditional radiation therapy.
When to Contact Your Surgical Oncology Team
Your surgical team will monitor you closely after surgery to address any complications early. Once you are home and recovering from IORT, more serious and unexpected complications of ORT to watch for include:
- Abnormal bleeding
- Discharge at the incision site
- Fever or chills
You should contact your surgical oncology team if you experience any of these symptoms.
What is the Success Rate of IORT?
One of the most important questions patients ask is: “Does IORT work as well as traditional radiation?” The answer, based on multiple clinical studies, is yes, but only for the right patients. Patient selection and tumor characteristics play a critical role in determining whether IORT can be as effective as standard radiation therapy.
Some studies suggest that certain patients treated with IORT may have a higher risk of local recurrence compared to those receiving traditional external beam radiation, especially if tumor features or risk factors are not carefully considered.
For these reasons, traditional radiation remains the safer and more thoroughly studied option for some patients, with longer-term data supporting its use.
However, for others, carefully selected early-stage cases can achieve comparable local control. Early-stage breast cancer is a good example. In these cases, research has shown that IORT provides comparable cancer control to external beam radiation therapy for carefully selected patients.
Success Rates and Long-Term Outcomes of IORT
While IORT can be as effective for the right patients, it is not universally interchangeable with traditional radiation and must be used thoughtfully in oncologic care.
For those who are candidates, outcomes are encouraging in well-selected patients.
- 5-year local recurrence rate: Studies show that IORT is associated with a local recurrence rate of approximately 7 percent at five years for low-risk patients, which is comparable to or only slightly higher than traditional radiation therapy in this group.
- Survival rates: Long-term survival rates for patients treated with IORT are similar to those treated with external beam radiation, indicating that IORT can be as effective at preventing cancer from returning in appropriately selected patients.
- Patient experience: Patients who receive IORT often report higher satisfaction with their treatment experience due to single-session convenience, fewer skin-related effects, and a faster return to daily routines.
While it’s only become more talked about and accessible in recent years, IORT has been FDA cleared for clinical use since 1999 and has been used in thousands of patients worldwide. Ongoing research continues to refine patient selection criteria and optimize dosing and technique, opening the door for IORT to become a reliable option for even more eligible patients.
As with any cancer treatment, individual results depend on many factors, including the type and stage of cancer, tumor biology and margins, overall health, and response to therapy. Your oncology team will discuss your specific prognosis and help you set realistic expectations.
When Additional Radiation Could Be Needed After IORT
About 20 percent of patients who receive IORT may still need supplemental external beam radiation therapy based on final pathology results. This is not a failure of IORT. It is a precaution to ensure the best possible long-term control when risk features are present.
Supplemental external radiation is more likely to be recommended when any of the following are found after surgery:
- Positive or close surgical margins
- Lymph node involvement
- Larger tumor size relative to breast size or involved field
- High-risk tumor features, such as lymphovascular invasion or aggressive histology
- Multifocal or multicentric disease identified on final pathology
In these scenarios, IORT still delivers immediate targeted radiation to the tumor bed, and the additional external beam course is used to address broader field risk.
How Does Intraoperative Radiation Therapy (IORT) Work?
During cancer surgery, once the tumor has been removed, there is a brief window of time when the tumor bed (the area where the tumor was located) is fully exposed and visible to the surgical team. Instead of closing the incision, waiting for the patient to fully recover from surgery, and then sending them for weeks of daily outpatient radiation, this is when IORT is performed.
The concept behind IORT is simple yet powerful. Immediately after tumor removal, a radiation oncologist delivers a single, high dose of radiation directly to the tumor bed using a specialized applicator. Healthy tissue is temporarily moved out of the way to minimize exposure, allowing the radiation to precisely target any microscopic cancer cells that may remain.
IORT adds only a short amount of time to the overall surgery but eliminates the need for weeks of daily radiation treatments, saving significant time and reducing disruption to daily life.
What to Expect During IORT Treatment
Intraoperative Radiation Therapy (IORT) combines cancer surgery and radiation treatment in a single operative session. A surgical oncologist removes the tumor, then a radiation oncologist delivers a single, high dose of radiation directly to the area where the cancer was removed, all within the same procedure.
Because surgery is part of the process, IORT is performed in a hospital operating room or a surgical suite equipped with specialized radiation technology. The specifics can vary depending on the type and location of the cancer, but the process generally follows this sequence:
- Anesthesia: Before the procedure, an anesthesiologist administers general anesthesia to put you into a deep sleep, ensuring you are comfortable and unaware during the entire surgery.
- Tumor Removal: Once you are under anesthesia, your surgical team begins the cancer removal process. The surgical oncologist carefully removes the tumor along with any surrounding tissue that may contain cancer cells.
- Radiation Preparation: After the tumor is removed, the tumor bed is prepared for radiation. Nearby healthy tissue and organs are gently moved aside or shielded to protect them from exposure.
- Placement of Radiation Applicator: A specialized applicator (a device designed to deliver radiation precisely to the treatment site) is positioned in the tumor cavity.
Several types of applicators can be used, depending on the technology available at the surgical center and target site. Spherical applicators, such as the Zeiss Intrabeam Smart applicator, are most commonly used for breast lumpectomy cavities. Harrison-Anderson-Mick (H.A.M.) is another commonly used applicator. Flat, surface, or needle applicators might also be used. - Delivery of Radiation: You remain under anesthesia while your radiation oncologist prescribes and delivers a single, concentrated dose of radiation through the applicator. The process typically takes 15 to 40 minutes, depending on the size and location of the area being treated.
- Applicator Removal: Once the radiation is complete, the applicator is carefully removed from the surgical site.
- Incision Closure: Your surgeon then closes the incision, completing the procedure.
- Recovery: You will be moved into a recovery area where you will be monitored. When you wake up, both your tumor removal and radiation treatment will be complete. Most patients, particularly those treated for early-stage breast cancer, can return home the same day.
Your oncology care team will provide detailed instructions for recovery, including how to care for your incision and manage any post-surgical discomfort.
Frequently Asked Questions About IORT
How long does the IORT procedure take?
IORT combines surgical removal of a tumor with radiation therapy. The radiation delivery itself adds only minutes to the total surgery time, typically 15 to 40 minutes extra, depending on the size and location of the treatment area.
However, because IORT is performed during cancer surgery, the entire procedure may take several hours from start to finish, which is similar to other complex cancer surgeries.
Is IORT painful?
No, IORT is not painful. IORT is performed while you are under general anesthesia, so you will not feel any pain during the procedure. After surgery, some post-surgical soreness or fatigue is normal and can be managed with your prescribed pain medication and rest.
Is IORT covered by insurance?
Yes. Most insurance plans cover IORT because it is an FDA-approved radiation therapy technique. However, coverage varies by plan, diagnosis, and treatment center. It’s best to confirm coverage directly with your insurance provider or let our patient care team assist you before scheduling.
Will I need additional radiation after IORT?
For most patients, IORT is the only radiation treatment needed. However, about 20 percent of patients may need additional external beam radiation based on final pathology results. Should EBRT be needed, the good news is that the number of EBRT sessions is typically much fewer compared to EBRT alone.
How soon can I return to normal activities after IORT?
Recovery time from IORT varies depending on the type of surgery performed. Many patients can resume light activities within one to two weeks, with a faster overall recovery compared to traditional radiation therapy since no follow-up radiation sessions are required.
What is the difference between IORT and brachytherapy?
Both IORT and brachytherapy deliver radiation internally, but they differ in timing and technique. IORT is performed once, during surgery, immediately after the tumor is removed. Brachytherapy involves placing temporary radioactive seeds or applicators that release radiation over several days or weeks. IORT is typically faster, more targeted, and more convenient for eligible patients.
Is IORT the Best Radiation Treatment?
Determining whether Intraoperative Radiation Therapy (IORT) is the best radiation treatment technique for you depends on the type of cancer, the size and location of the tumor, your overall health, and your individual treatment goals.
If you are facing a cancer diagnosis, let your oncologic surgeon know that you are interested in IORT. They can evaluate your case, review your imaging and pathology results, and help you decide if IORT fits safely and effectively into your treatment plan.
IORT represents a significant advancement in how advanced surgical oncology centers like The Surgical Clinic in Tennessee approach cancer treatment. By combining surgery and radiation into a single procedure, IORT offers patients a more convenient, precise, and effective option with fewer side effects and a faster path to recovery.
While IORT is not appropriate for every patient or every cancer, for those who qualify, it can make a meaningful difference in both the treatment experience and the long-term outcome.
As research continues and technology advances, IORT is expected to become an option for an even wider range of cancers, giving more patients the opportunity to benefit from this innovative approach to radiation therapy.
IORT Cancer Treatment in Middle Tennessee
If you’re in the Nashville area and searching to find out if IORT is available near you, advanced cancer care, including innovative treatments like IORT, is accessible right here in Middle Tennessee, at The Surgical Clinic.
We have an advanced oncology division with a team of experienced surgical oncologists and radiation specialists who are committed to providing the most advanced, patient-centered care available, including IORT.
When it comes to cancer treatment, experience matters. Our surgeons have extensive training in the latest surgical techniques, including minimally invasive and precision-guided procedures that can improve outcomes and speed recovery.
We work closely with radiation oncologists, medical oncologists, and other specialists to create a comprehensive cancer treatment plan tailored to your unique needs.
We understand that a cancer diagnosis is overwhelming. We’re here to help you navigate your options with compassion, expertise, and a focus on both your long-term health and overall quality of life.
Taking the Next Step for Advanced Cancer Care Close to Home
If you or a loved one has been diagnosed with cancer and you’re interested in learning more about Intraoperative Radiation Therapy (IORT) or other minimally invasive cancer treatment options, cancer care close to home is available at The Surgical Clinic.
Cancer treatment isn’t one-size-fits-all, and neither is our approach to care. We’re here to listen, to guide, and to support you every step of the way. Our expert surgical oncology team will take the time to answer your questions, review your diagnosis, and help you understand whether IORT or another treatment approach is right for you.
Contact The Surgical Clinic today to schedule a consultation and explore your cancer treatment options in Middle TN.