Intraoperative Radiation Therapy (IORT) to the Breast

This information will help you prepare for intraoperative radiation therapy (IORT) to the breast at Memorial Sloan Kettering (MSK).

Radiation therapy can be used to reduce the risk of a tumor returning once it was removed. IORT is a high dose of radiation that is given during a surgery, to the area where the cancer was removed. IORT does as little damage as possible to normal tissue around where the tumor used to be.

IORT is different from standard radiation therapy. Standard radiation therapy treats the whole breast. IORT treats only the tissue surrounding the breast tumor. Most of the time, if your cancer does come back, it comes back near the site of the first cancer. This is the tissue that will be treated with IORT.

Whether you have IORT or traditional radiation to the whole breast will depend on several factors, including, your age, the size of the tumor, the type of cancer cells that make up the tumor, and the size of your breast.

Before Your Procedure

You will have IORT during your lumpectomy surgery. Your nurse will help you prepare and will give you a resource called Getting Ready for Surgery.

Arrange for someone to take you home

You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone to take you home.

  • Partners in Care: 888-735-8913
  • Caring People: 877-227-4649
  • Prime Care: 212-944-0244

Instructions for eating and drinking before your procedure

12 ounces of water

  • Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.
  • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
  • Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
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The Day of Your Procedure

Where to go

Please go to the Presurgical Center (PSC) at 1275 York Avenue between East 67th and East 68th Streets. This is the main building of MSK. Take the B elevator to the 6th floor.

What to expect

Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar names may be having procedures on the same day.

After changing into a hospital gown, you will meet your nurse. He or she will place an intravenous (IV) catheter into a vein, usually in your hand or arm. At first you will receive fluids through the IV, but it will be used later to give you anesthesia (medication to make you sleepy). Your doctor will explain the procedure and answer any questions you have.

When it’s time for your procedure, you will be brought into the operating room. You will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through your nose. You will receive anesthesia through your IV, which will make you fall asleep.

Once you are asleep, your doctor will make an incision (surgical cut) across your chest and  remove your tumor. Your doctor will also check the tissue near the tumor to make sure there are no other lumps.

After the tumor is removed, your radiation oncologist will place an applicator into your incision. The applicator has thin catheters (small, flexible tubes) that are connected to a machine that holds the radiation.

Once the applicators are positioned correctly, your healthcare team will leave the room, close the door, and begin your treatment. It will take 30 to 40 minutes for you to receive the full dose of radiation. Although you are alone during your treatment, your healthcare team can see you on a monitor and hear you through an intercom at all times.

When your treatment is done, your healthcare team will return to the room. Your surgeon will remove the applicator and close your incision.

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After Your Procedure

In the hospital

You will be taken to the Post Anesthesia Care Unit (PACU), where your nurse will monitor your temperature, heart rate, breathing, and blood pressure. You will stay in the PACU until you are fully awake.

You may have a small drain in your breast that allows fluid to exit. You may get antibiotics during the surgery to help prevent infection. You may also need to take them after you go home.

At home

You will have follow-up appointments with your surgeon and radiation oncologist. Call each office to schedule the appointment.

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Side Effects

Some people develop side effects from treatment. The type and how severe they are depend on how much radiation you received and your overall health.

Your skin in the treated area will become:

  • Red
  • Dark
  • Dry
  • Irritated (similar to a sunburn)

The redness and irritation will get better after your treatment is done. Your skin in the treated areas will always be drier than usual. Your nurse will teach you how to care for your skin.

Permanent side effects from IORT are not common; however, you may notice a change in your treated breast. Your breast may feel hard and may change in appearance. This may happen 6 months or more after your treatment has been completed.

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