title: Intraoperative radiation therapy (IORT) in head and neck cancer: A systematic review.
abstract: BACKGROUND
  Multimodality therapy constitutes the standard treatment of advanced and recurrent head and neck cancer. Since locoregional recurrence comprises a major obstacle in attaining cure, the role of intraoperative radiation therapy (IORT) as an add-on in improving survival and local control of the disease has been investigated. IORT allows delivery of a single tumoricidal dose of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. Advantages of IORT include the conformal delivery of a large dose of radiation in an exposed and precisely defined tumor bed, minimizing the risk of a geographic miss creating the potential for subsequent dose reduction of external beam radiation therapy (EBRT). This strategy allows for shortening overall treatment time and dose escalation. The aim of this review is to summarize recent published work on the use of IORT as an adjuvant modality to treat common head and neck cancer in the primary or recurrent setting.
  
  
  METHODS
  We searched the Medline, Scopus, Ovid, Cochrane, Embase, and ISI Web of Science databases for articles published from 1980 up to March 2016.
  
  
  RESULTS
  Based on relevant publications it appears that including IORT in the multimodal treatment may contribute to improved local control. However, the benefit in overall survival is not so clear.
  
  
  CONCLUSIONS
  IORT seems to be a safe, promising adjunct in the management of head and neck cancer and yet further well organized clinical trials are required to determine its role more precisely.
authors.affiliation: Department of Radiotherapy/Radiation Oncology Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly 2nd Department of Radiology-Radiotherapy Unit, ATTIKON University Hospital, Medical School, University of Athens Hellenic Anticancer Institute, St-Savvas Anticancer Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Kyrgias
authors.forename: Jiannis
authors.initials: J
authors.lastname: Hajiioannou
authors.forename: Maria
authors.initials: M
authors.lastname: Tolia
authors.forename: Vassilios
authors.initials: V
authors.lastname: Kouloulias
authors.forename: Vasileios
authors.initials: V
authors.lastname: Lachanas
authors.forename: Charalambos
authors.initials: C
authors.lastname: Skoulakis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Skarlatos
authors.forename: Alexandros
authors.initials: A
authors.lastname: Rapidis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Bizakis
mesh_terms: D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D011379:Prognosis; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome