Interventional procedure overview of intraoperative electron beam radiotherapy for locally advanced and locally recurrent colorectal cancer
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Existing assessments of this procedure
In 2022, the National Comprehensive Cancer Network (NCCN) published clinical practice guidelines on rectal cancer (NCCN, 2022). The guidelines recommend that:
'Intraoperative radiation therapy (IORT), if available, may be considered for very close or positive margins after resection, as an additional boost, especially for patients with T4 or recurrent cancers.'
In 2020, the European Society for Radiotherapy and Oncology/Advisory Committee for Radiation Oncology Practice (ESTRO/ACROP) published recommendations for primary locally advanced (Calvo, 2020a) and locally recurrent (Calvo, 2020b) rectal cancer. The recommendations were published to define clinical indications, patient selection criteria, and technical aspects of IORT. The publication notes that:
'IORT for LARC/LRRC has predominantly been delivered with megavoltage electrons produced by a medical linear accelerator (IOERT). There are not sufficient scientific data to support the use of brachytherapy or orthovoltage delivery systems for IORT.'
In 2019, the American Brachytherapy Society published a consensus statement on IORT for several types of cancer (Tom, 2019). For colorectal cancers, the recommendations were:
'IORT can be considered at the time of surgical resection of locally advanced or recurrent colorectal cancer in cases with concern for a positive margin, particularly when pelvic EBRT has already been delivered. A dose of 15 Gy in a single treatment to 5 mm depth in tissue using IORT-HDR has been used. However, doses less than or equal to 12.5 Gy in a single fraction should be used to reduce the risk of neuropathy when IOERT is used.'
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