Intraoperative irradiation as multimodal therapy approach in epithelial gastrointestinal carcinoma

Surgery alone often fails to achieve local control in advanced gastrointest inal tumors. With multimodal therapy approaches, both local tumor control a nd long-term survival appear to be improved. Intraoperative radiation thera py (IORT) is an attempt to achieve higher doses of irradiation while dose-l imiting structures are surgically displaced. It has been shown previously t hat both local tumor control and long-term survival are improved in patient s undergoing surgery combined with IORT for both primary and recurrent rect al carcinoma. In advanced gastric carcinoma, IORT has achieved optimistic s urvival results in a few studies. In locally advanced pancreatic cancer, an apparent improvement in local control has been noted with IORT, but surviv al has not been prolonged because of a high incidence of both liver and per itoneal metastases. The data concerning IORT for esophageal carcinoma are n ot yet sufficient to allow judgement.