Intraoperative Radiotherapy

  • H. J. Hoekstra
  • F. A. Calvo


Today combined modality therapies comprising surgery, chemotherapy, and radiation procedures are used in the treatment of a variety of malignancies and have shown an improvement in the 5-year survival rates. New surgical techniques have been developed, and new and effective chemotherapeutics have become available. Progress is still being made in the development of new chemotherapeutic agents and less toxic drug dose schedules. Progress in radiation therapy has been achieved by the improvements in technical equipment and technical advances in methods of radiation therapy, including the use of computerized planning of radiation therapy and multiple fields. The aim has been to increase the dose to the tumor and minimize the dose to the adjacent normal tissues, thereby increasing the local control rate without increasing the complication rate. The delivery of tumoricidal doses of radiation with external beam techniques, especially the treatment of intra-abdominal, retroperitoneal, or pelvic malignancies, can be accompagnied by a short- or long-term toxicity to normal tissues.


Biliary Tract Cancer Unresectable Pancreatic Cancer Retroperitoneal Sarcoma Extrahepatic Bile Duct Carcinoma Unresectable Pancreatic Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abe M (1984) Intraoperative radiation therapy for gastrointestinal malignancy. In: DeCosse JJ, Sherlock P, (eds) Clinical management of gastrointestinal cancer. Nijhoff, Boston, pp 327–351 (Cancer treatment and research, vol 18)CrossRefGoogle Scholar
  2. Abe M, Shibamoto Y, Takahasi M, Manabe T, Tobe T, Inamoto T (1987) Intraoperative radiotherapy in carcinoma of the stomach and pancreas. World J Surg 11: 459–464PubMedCrossRefGoogle Scholar
  3. Abe M, Arakawa M (1967) Fundamental studies on surgical irradiation. Histological and hematological changes following irradiation during laparotomy of dogs. Jpn Soc Cancer Ther 2: 271–278Google Scholar
  4. Abe M, Takahashi M (1981) Intraoperative radiotherapy: the Japanese experience. Int J Radiat Oncol Biol Phys 7: 863–868PubMedCrossRefGoogle Scholar
  5. Abe M, Yabumoto E, Takahashi M, Tobe T, Mori K (1974) Intraoperative radiotherapy of gastric cancer. Cancer 34: 2034–2041PubMedCrossRefGoogle Scholar
  6. Arian-Schad K, Leitner M, Jüttner F, Kohek P, Hackl A, Friehs G, Combined intraoperative (IORT) and external radiation therapy in patients with nonresectable non-small-cell lung cancer (NSCLC). In progress in radio-oncology IV. Karcher, Kogelnik, Szepesi, (eds). Vienna 1989: submitted/ in pressGoogle Scholar
  7. Ashayeri E, Dallas T, Goldson AL, Seton M, Conseption DT, Manning JC (1986) Anesthesia in intraoperative radiotherapy patients. J Natl Med Assoc 78: 193–199PubMedGoogle Scholar
  8. Bakker D, Kruize HH, Hoekstra HJ, Mehta DM, Crommelin MA (1984) Electron beam treatment: clinical, technical and dosimetric aspects. Med Phys 11: 410Google Scholar
  9. Barnes M, Pass H, DeLuca A, Tochner Z, Potter O, Terrill R, Sindelar WF, Kinsella TJ (1987) Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT). Int J Radiat Oncol Biol Phys 13: 371–378PubMedCrossRefGoogle Scholar
  10. Barth G, Meinel F (1959) Intraoperative Kontakttherapie in den großen Körperhöhlen. Strahlentherapie 109: 386–395PubMedGoogle Scholar
  11. Beck C (1909) An external roentgen treatment of internal structures (eventration treatment). NY Med J 89: 621–622Google Scholar
  12. Biggs PJ, Epp ER, Ling CC, Novack DH, Michaels HB (1983) Dosimetry, field shaping and other considerations for intraoperative electron therapy. Int J Radiat Oncol Biol Phys 7: 875–884Google Scholar
  13. Buskirk SJ, Gunderson LL, Adson MA, et al. (1984) Analysis of failure following curative irradiation of gall bladder and extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys 10: 2013–2023PubMedCrossRefGoogle Scholar
  14. Delgado G, Goldson AL, Ashayeri E, Hill LT, Petrill ES, Hatch KD (1984) Intraoperative radiation in the treatment of advanced cervical cancer. J Obstet Gynecol 63: 246–252Google Scholar
  15. Eloesser L (1937) The treatment of some abdominal cancers by irradiation through the open abdomen combined with cautery excision. Ann Surg 645–652Google Scholar
  16. Fairchild GC, Shorter A (1947) Irradiation of gastric cancer. Br J Radiol 20: 511–522PubMedCrossRefGoogle Scholar
  17. Fraass BA, Harrington FS, Kinsella TF, Sindelar WF (1983) Television system for verification and documentation of treatment fields during intraoperative radiotherapy. Int J Radiol Oncol Biol Phys 9: 1409–1411CrossRefGoogle Scholar
  18. Fraass BA, Miller RW, Kinsella TJ et al. (1985) Intraoperative radiation therapy at the National Cancer Institute: technical innovations and dosimetry. Int J Radiat Oncol Biol Phys 11: 1299–1311PubMedCrossRefGoogle Scholar
  19. Glenn J, Sindelar WF, Kinsella TF et al. (1985) Results of mul-timodality therapy of resectable soft tissue sarcomas of the retroperitoneum. Surgery 97: 316–325PubMedGoogle Scholar
  20. Goldson AL, Ashayeri E, Espinoza MC, et al. (1981) Single dose intraoperative electrons for advanced stage pancreatic cancer: phase 1 pilot study. Int J Radiat Oncol Biol Phys 7: 869–874PubMedCrossRefGoogle Scholar
  21. Goldson AL, Sheeter OE, Ashayeri E, Collier-Manning J, Barber JB, Fan KJ (1984) Intraoperative radiotherapy for intracranial malignancies. Cancer 54: 2807–2813PubMedCrossRefGoogle Scholar
  22. Gunderson LL, Tepper JE, Biggs PJ, Goldson AL, Martin JK, McCullough EC, Rich TA, et al. (1983) Intraoperative ± external beam irradiation. Curr Probl Cancer 7: 11CrossRefGoogle Scholar
  23. Gunderson LL, Martin JK, O’Conell MJ, Beart RW, Kuols LK, Nagorney DM (1985) Residual, recurrent, or unresectable gastrointestinal cancer. Cancer 55: 2250–2258PubMedCrossRefGoogle Scholar
  24. Gunderson LL, Martin JK, Beart RW, Nagorney DM, Fieck JM, Wiland HS, Martinez A, O’Connell MJ, Martenson IA, Mcllrath DC (1988) Intraoperative and external beam irradiation for locally advanced colorectal cancer. Ann Surg 207: 52–60PubMedCrossRefGoogle Scholar
  25. Hahn GM (1982) Hyperthermia and cancer. Plenum, New YorkGoogle Scholar
  26. Hoekstra HJ, Kinsella TJ, Maher M, Smith R, Tochner ZA, Sindelar WF (1985) Treatment complications related to intraoperative radiotherapy (Abstr C-989). Proceedings of the American Society of Clinical Oncology. Waverly Baltimore, p 252Google Scholar
  27. Hoekstra HJ, Mehta DM, Humphrey GB, Vermeij J, Oldhoff J (1986) Intraoperative radiotherapy. A new combined modality therapy in pediatric oncology. Pediatr Res 20:1045CrossRefGoogle Scholar
  28. Hoekstra HJ, Sindelar WF, Kinsella TJ, Oldhoff J (1987) History, preliminary results, complications and future prospects of intraoperative radiotherapy. J Surg Oncol 36: 175–182PubMedCrossRefGoogle Scholar
  29. Hoekstra HJ, Mehta DM, Oldhoff J, Vermeij J, Crommelin M (1988 a) The development of an intraoperative radiotherapy program - the Groningen IORT project. In: Dobelbower RR, Abe M, (eds) Intraoperative radiation therapy. CRC, Boca Raton (in press)Google Scholar
  30. Hoekstra HJ, Restrepo C, Kinsella TJ, Sindelar WF (1988 b) Histopathological effects of intraoperative radiotherapy on pancreas and adjacent tissues: a postmortem analysis. J Surg Oncol 37: 104–108PubMedCrossRefGoogle Scholar
  31. Kaufman BH, Gunderson LL, Evans RG, Burgert EO, Gilchrist GS, Smithson WA (1984) Intraoperative irradiation: a new technique in pediatric oncology. J Pediatr Surg 19: 861–862PubMedCrossRefGoogle Scholar
  32. Kinsella TJ, Sindelar WF (1985) Intraoperative radiotherapy. In: DeVita VT, Hellman S, Rosenberg SA, (eds) Cancer, principles and practice of oncology. Lippincott, Philadelphia, pp 2293–2304Google Scholar
  33. Kinsella TJ, Sindelar WF, DeLuca A, Barnes M, Tochner Z, Mixon A, Terrill R (1988) Tolerance of the bladder to intraoperative radiotherapy (IORT): an experimental study. Int J Radiat Oncol Biol Phys 14: 939–946PubMedCrossRefGoogle Scholar
  34. Kinsella TJ, Sindelar WF, DeLuca AM, Pezekkpour G, Smith R, Maher M, Terrill R, et al. (1985) Tolerance of peripheral nerve to intraoperative radiotherapy (IORT): clinical and experimental studies. Int J Radiat Oncol Biol Phys 11: 1579–1585PubMedCrossRefGoogle Scholar
  35. Kinsella TJ, Sindelar WF, Lack E, Glatstein E, Rosenberg SA (1988) Preliminary results of a randomized study of adjuvant radiation therapy in resectable adult retroperitoneal soft tissue sarcomas. J Clin Oncol 6: 18–25PubMedGoogle Scholar
  36. Matsumoto K, Kakizoe T, Mikuriya S, Tanaka T, Kondo J, Umegaki Y (1981) Clinical evaluation of intraoperative radiotherapy for carcinoma of the urinary bladder. Cancer 47: 509–513PubMedCrossRefGoogle Scholar
  37. McCullough EC, Anderson JA (1982) Dosimetric properties of an applicator system for intraoperative electron beam therapy utilizing a Clinac-18 accelerator. Med Phys 9: 261–268PubMedCrossRefGoogle Scholar
  38. McCullough EC, Gunderson LL (1988) Energy as well as applicator size and shape utilized in over 250 intraoperative electron bean procedures. Int J Radiat Oncol Biol Phys 15: 1041–1042PubMedCrossRefGoogle Scholar
  39. NIH, National Institutes of Health (1984) Intraoperative radiation therapy. JAMA 251: 3086–3087CrossRefGoogle Scholar
  40. Pack GT, Livingston EM (1940) Treatment of cancer and allied diseases, 2nd edn. Hoeber, New York, pp 1088–1109Google Scholar
  41. Pass HI, Sindelar WF, Kinsella TJ, DeLuca A, Barnes AM, Kurtzman S, Hoekstra HJ et al. (1987) Delivery of intraoperative radiation therapy after pneumectomy: experimental observations and early clinical results. Ann Thorac Surg 44: 14–20PubMedCrossRefGoogle Scholar
  42. Phillips TL (1985) Radiation sensitizers and protectors. In: De-Vita VT, Hellman S, Rosenberg SA, (eds) Cancer, principles and practice of oncology. Lippincott, Philadelphia, pp 2256–2271Google Scholar
  43. Rich TA, Cady B, McDermott WV, Kase KR, Chaffey JT, Hellmann S (1984) Orthovoltage intraoperative radiation therapy: a new look, an old idea. Int J Radiat Oncol Biol Phys 10:1957–1965PubMedCrossRefGoogle Scholar
  44. Schumann EA (1933) Direct intraabdominal radiation in advanced pelvic carcinoma. Am J Obstet Gynecol 26: 260–263Google Scholar
  45. Shaw EG, Blackwell CR, McCullough EC, Gunderson LL (1987) Matching intraoperative electron beam fields: dosimetric and clinical considerations. Int J Radiat Oncol Biol Phys 13: 1303–1307PubMedCrossRefGoogle Scholar
  46. Shaw EG, Gunderson LL, Martin JK, Beart RW, Nagorney AM, Podratz KC (1988) Peripheral nerve and ureteral tolerance to intraoperative radiation therapy: clinical and dose-response analysis. Int J Radiat Oncol Biol Phys (in press)Google Scholar
  47. Shipley WU, Wood WC, Tepper JE et al. (1984) Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma. Ann Surg 200: 289–296PubMedCrossRefGoogle Scholar
  48. Shipley WU, Kaufman DS, Prout GR (1987) Intraoperative radiation therapy in patients with bladder cancer. A review of techniques allowing improved tumor doses and providing high cure rates without loss of bladder function. Cancer 60: 1485–1488PubMedCrossRefGoogle Scholar
  49. Sindelar WF, Kinsella TJ (1986 a) Randomized trial of intraoperative radiotherapy in resected carcinoma of the pancreas. Int J Radiat Oncol Biol Phys [Suppl 1] 12: 148Google Scholar
  50. Sindelar WF, Kinsella TJ (1986 b) Randomized trial of intraop erative radiotherapy in unresectable carcinoma of the pancreas. Int J Radiat Oncol Biol Phys [Suppl 1] 12: 148Google Scholar
  51. Sindelar WF, Tepper J, Travis EL, Terrill R (1982 a) Tolerance of retroperitoneal structures to intraoperative radiation. Ann Surg 96: 601–608CrossRefGoogle Scholar
  52. Sindelar WF, Tepper J, Travis EL (1982 b) Tolerance of bile duct to intraoperative irradiation. Surgery 92: 533–540PubMedGoogle Scholar
  53. Sindelar WF, Morrow BM, Travis EL, Tepper J, Merkel AB, Kranda K, Terrill R (1983 a) Effects of intraoperative electron irradiation in the dog on cell turnover in intact and surgically-anastomosed aorta and intestine. J Radiol Oncol Biol Phys 9: 523–532CrossRefGoogle Scholar
  54. Sindelar WF, Kinsella TJ, Tepper J, Travis EL, Rosenberg SA, Glatstein E (1983 b) Experimental and clinical studies with intraoperative radiotherapy. Surg Gynecol Obstet 157: 205–219PubMedGoogle Scholar
  55. Sindelar WF, Kinsella TJ, Hoekstra HJ, Tochner ZA, Smith R, Maher M (1985) Duodenal hemorrhage as a complication of intraoperative radiotherapy for unresectable carcinomas of the pancreas (Abstr C–1075). Proceedings of the American Society of Clinical Oncology, Waverly, Baltimore, p 277Google Scholar
  56. Sindelar WF, Hoekstra HJ, Restrepo C, Kinsella TJ (1986) Pathological tissue changes following intraoperative radiotherapy. Am J Clin Oncol 9: 504–509PubMedCrossRefGoogle Scholar
  57. Sindelar WF, Hoekstra HJ, Kinsella TJ, Barnes M, DeLuca AM, Tochner Z, Pass HI, Kranda KC et al. (1988 a) Tolerance of canine esophagus to intraoperative electron beam radiotherapy. Int J Radiat Oncol Biol Phys 15: 663–669PubMedCrossRefGoogle Scholar
  58. Sindelar WF, Hoekstra HJ, Kinsella TJ (1988 b) Surgical approaches and techniques in intraoperative radiotherapy for intraabdominal, retroperitoneal and pelvic neoplasms. Surgery 103: 247–256PubMedGoogle Scholar
  59. Suit HD (1973) Radiation biology. In: Fletcher GH, (ed) A basis for radiotherapy. Textbook of radiotherapy. Lea and Febiger, Philadelphia, pp 75–121Google Scholar
  60. Takahashi M, Okada K, Shibamoto Y, Abe M, Yoshida O (1985) Intraoperative radiotherapy in the definitive treatment of localized carcinoma of the prostate. Int J Radiat Oncol Biol Phys 11: 147–151PubMedCrossRefGoogle Scholar
  61. Tepper JE (1985) Intraoperative radiation therapy for pancreatic carcinoma. In: Fortner JG, Roads JE, (eds) Accomplishments in cancer research 1984. Lippincott, Philadelphia, pp 249–257Google Scholar
  62. Tepper JE, Sindelar WF, Travis EL, Terrill R, Padikal T (1983) Tolerance of canine anastomosis to intraoperative radiation therapy. Int J Radiol Oncol Biol Phys 9: 987–991CrossRefGoogle Scholar
  63. Tepper JE, Gunderson LL, Orlow E, Cohen AL, Hedberg SE, Shipley WU, Blitzer PH, Rich T (1984) Complications of intraoperative radiotherapy. Int J Radiat Oncol Biol Phys 10: 1831–1839PubMedCrossRefGoogle Scholar
  64. Tepper JE, Wood WC, Cohen AM et al. (1985) Intraoperative radiation therapy. In: DeVita VT, Hellman S, Rosenberg SA, (eds) Important advances in oncology 1985. Lippincott, Philadelphia, pp 226–242Google Scholar
  65. Tepper JE, Gunderson LL, Goldson AL, et al. (1986) Quality control parameters of intraoperative radiation therapy. Int J Radiat Oncol Biol Phys 12: 1687–1695PubMedCrossRefGoogle Scholar
  66. Todoroki T (1978) The late effects of single massive irradiation with electrons of the liver hilum in rabbits. Jpn J Gastroenterol Surg 11: 169–177CrossRefGoogle Scholar
  67. Todoroki T, Iwasaki Y, Okamura T, et al. (1980) Intraoperative radiotherapy for advanced carcinoma of the biliary system. Cancer 46: 2179–2184PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • H. J. Hoekstra
  • F. A. Calvo

There are no affiliations available

Personalised recommendations