Anesthesia in intraoperative radiotherapy patients

Intraoperative radiotherapy (IOR) is a relatively new modality for the treatment of carcinoma. This modality necessitates a multidisciplinary approach among the surgeon, anesthesiologist, radiotherapist, pathologist, and other members of the surgical support team. In addition to appropriate IOR and surgical techniques, the role of the anesthesiologist is crucial in determining patient outcome. Specifically, the degree of preoperative preparation has a direct correlation with a successful postoperative course. Patients considered for surgery are grouped in terms of: (1) primary tumor with no metastasis and/or unresectable loco-regional disease; (2) clinical and investigational evidence of tumor with no proven malignancy; and (3) those with known metastasis but in otherwise good general condition.The primary surgical goal is to localize the tumor, obtain a frozen-section biopsy, and evaluate for resectability at the same time as the radiotherapist evaluates whether IOR is indicated. Thus many facets come together to make the IOR procedures feasible and safe. The 148 patients treated at Howard University Hospital, uneventfully, should serve to justify intraoperative radiotherapy as both a practical and safe tool in the treatment of malignancy.