This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Systematic Review of Intraoperative Radiotherapy (IORT) in Head and Neck Oncology: Past, Present, and Future Perspectives
by
, ,
Laurence Pincet
1,†
,
Aurelie Fanchette
1,*,†,
Jolanda Elmers
2,
Jean Bourhis
3, 
Karma Lambercy
1,‡ and
Edouard Romano
3,‡ 1
ENT, Head and Neck Department, CHUV, Rue du Bugnon 46, 1010 Lausanne, Switzerland
2
Pole Formation, Recherches–Soutien aux Revus Systématiques, Bibliothèque Universitaire de Médecine, Chemin des Falaises 2, 1005 Lausanne, Switzerland
3
Radiation Oncology Department, CHUV, Rue du Bugnon 46, 1010 Lausanne, Switzerland
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
These authors also contributed equally to this work.
Cancers 2025, 17(13), 2124; https://doi.org/10.3390/cancers17132124
Submission received: 25 April 2025
/
Revised: 13 June 2025
/
Accepted: 17 June 2025
/
Published: 24 June 2025
(This article belongs to the Collection Advances in Diagnostics and Treatment of Head and Neck Cancer)
Simple Summary
Intraoperative radiotherapy (IORT) is a technique that delivers a high dose of radiation directly to the tumor bed during surgery, aiming to improve local control while sparing surrounding healthy tissues. It has been used primarily in advanced or recurrent head and neck cancers, especially in patients previously treated with external beam radiotherapy. While promising, the evidence remains limited to mostly retrospective, single-institution studies with heterogeneous methodologies and outcomes. Complication rates can be high, and logistical challenges such as equipment availability and surgical coordination limit its broader use. This review examines current indications, outcomes, and practical limitations of IORT.
Abstract
Background/Objectives: Intraoperative radiotherapy (IORT) has been used for decades to improve local control in advanced and recurrent head and neck cancers by delivering a concentrated dose of radiation directly to the tumor bed during surgery. Despite its potential advantages, IORT remains controversial due to its high complication rates and logistical complexity. This systematic review aims to assess the current evidence on IORT in head and neck oncology, evaluating its indications, effectiveness, and limitations. Methods: A systematic literature review was conducted in accordance with Cochrane systematic review method and reported following PRISMA guidelines. Databases, including Medline, Embase, Cochrane, and Web of Science, were searched for studies evaluating IORT in head and neck cancer. Outcomes of interest included local control rates, overall survival, complications, and treatment logistics. Data were weighted based on patient numbers, and statistical analyses included weighted means and comparative tests. Results: Included in this review are 47 studies that included 2330 patients. The studies were highly heterogeneous, limiting definitive conclusions. IORT was mainly used in stage III/IV or recurrent tumors, with an average dose of 14.7 Gy (range: 1–40 Gy). The five-year local control was 47% to 82%. Complication rates included wound necrosis (22,3%), fistulas 34 (17.8%), and carotid blow-out (14.5%). Logistical constraints remain a major limitation. Conclusions: The heterogeneous data and logistic challenges of IORT in head and neck oncology have limited its use, and the benefits remain uncertain.
