What Is the Contribution of Intraoperative Radiotherapy (IORT) in Tailoring Local Therapy in Primary or Recurrent Rectal Cancer

Combined modality therapy, preferably preoperative chemoradiation and radical surgery, is the standard of care for local treatment in patients with locally advanced rectal cancer. Local control is expected superior to 85% at 5 years. Intraoperative radiotherapy (IORT) is a high-quality radiation-boosting technique for dose-escalation purposes in limited anatomic regions evaluated and considered at risk at the time of surgical resection. In-field IORT recurrence rates are inferior to 5% in primary disease. The experience available using IORT as a component of treatment, both in primary and localized recurrent disease, is reviewed. Factors associated to topographic (in-field control/recurrence) pelvic results are discussed to potentially guide a tailored use of IORT according to local risk estimations.