Intraoperative radiotherapy of head and neck cancer

Intraoperative radiotherapy (IORT) was developed as an adjuvant to surgery and external beam radiation for aggressive, extensive, or recurrent cancers of the head and neck. This report reviews the indications, technique, response, and complications of IORT. From May 1982 to May 1988, 104 patients received 15 to 20 Gy of radiation delivered through a Lucite cone to areas of high risk of recurrence following resection and prior to closure. The indications for treatment were (1) aggressive primary or recurrent cancer; (2) disease fixed to deep muscle, carotid, or bone; or (3) close margins in an effort to preserve vital structures or function. The IORT was effective in preventing local recurrence in 14 (40%) of 35 patients with 2-year follow-up of squamous cell carcinoma. The complication rate was acceptable. Intraoperative radiotherapy appears to be a safe and beneficial adjunctive therapy for cancers that historically have extremely dismal prognoses.