Intraoperative radiotherapy experimental and clinical results, future prospects

During the last two decades increasingly complex surgical techniques have been developed to improve the resection rate in the surgical treatment of cancer. There is an enormous growth in the development of new chemotherapeutic agents, and in the insight in chemotherapy treatment regimens. Since growth factors became available, high dose intensive chemotherapy combined with autologous bone marrow transplant can be performed with a low morbidity and mortality rate. Within radiation oncology technical advances in methods of radiation therapy, including the use of computerized planning (3D) treatment and conformal treatment have decreased the radiation-induced morbidity. To increase the radiation effect, e.g. to improve local control, without increasing radiation toxicity, hyper fractionation, radiation-sensitizers, and radiation-protectors were clinically investigated. New radiation techniques and equipment like brachytherapy (BT) units and intraoperative radiotherapy (IORT) became available. All these new techniques are today also used in the treatment of cancer as a combined modality treatment, with the idea to improve the local control rate, the disease free-, and overall survival without increasing or inducing treatment morbidity, and more over to prevent multilating surgical procedures.