Comparative analysis of intraoperative radiotherapy technologies

Abstract

Intraoperative radiotherapy (IORT) is a specialized technique where radiation is delivered directly to a tumour bed immediately after surgical removal, significantly reducing treatment duration and limiting damage to healthy tissue. Today, hospitals considering IORT face a challenging decision among electron-based systems (IOeRT), low-voltage X-ray units, high-dose-rate (HDR) brachytherapy, or conventional external-beam IMRT. Currently, there is no practical comparative guideline tailored to help hospital administrators select the most suitable system based on their specific clinical, logistical, and financial contexts. This thesis provides a comprehensive comparative analysis of these technologies by synthesizing information from an extensive review of the scientific literature, direct observations from leading hospitals in Barcelona, and structured interviews with medical physicists, radiation oncologists, surgeons, and healthcare managers. Each technology’s clinical indications, technical complexity, infrastructure demands, staffing needs, radiation safety requirements, and both initial and ongoing costs were systematically assessed. Findings reveal that IOeRT systems offer broad clinical versatility and short treatment times, though they require substantial infrastructure adjustments. Low-voltage systems offer simpler setup with minimal shielding but are restricted to specific, smaller surgical cavities. HDR brachytherapy excels in dose precision for irregular anatomical sites but adds operational complexity and ongoing source costs. IMRT provides extensive clinical applications but demands significant infrastructural investment and prolonged treatment schedules. Ultimately, this thesis serves as a practical resource, equipping hospital decision-makers with clear criteria to identify and implement the optimal IORT technology that aligns best with their institutional capabilities and patient care goals.