Intraoperative radiotherapy (IORT) is a radiation technique that allows for the delivery of a high radiation dose to the target while preserving the surrounding structures, which can be displaced during the surgical procedure. An important limitation of this technique is the lack of real-time image guidance, which is one of the main achievements of modern radiation therapy because it allows for treatment optimization. IORT can be delivered by low-energy X-rays or by accelerated electrons. The present review describes the most relevant clinical applications for IORT and discusses the potential advantages of using artificial intelligence (AI) to overcome some of the current limitations of IORT. In recent decades, IORT has proven to be an effective treatment in several cancer types. In breast cancer, IORT can be used to deliver a single dose of radiation (partial breast irradiation) or as a boost in high-risk patients. In locally advanced rectal cancer, a single dose to the tumor bed can improve local control and prevent pelvic relapse in primary and recurrent tumors. In sarcomas, IORT enables the delivery of high doses, achieving good functional outcomes with low toxicity in tumors located in the retroperitoneum and extremities. In pancreatic cancer, IORT shows promising results in borderline resectable and unresectable cases. Ongoing technological advances are addressing current challenges in imaging and radiation planning, paving the way for personalized, image-guided IORT. Recent innovations such as CT- and MRI-equipped hybrid operating theaters allow for real-time imaging, which could be used for AI-assisted segmentation and planning. Moreover, the implementation of AI in terms of machine learning, deep learning, and radiomics can improve the interpretation of imaging, predict treatment outcomes, and optimize workflow efficiency.
术中放疗是一种放射治疗技术，可在手术过程中通过移位周围组织实现对目标区域的高剂量照射，同时保护邻近正常结构。该技术的重要局限在于缺乏实时影像引导，而影像引导正是现代放射治疗实现治疗优化的主要成就之一。术中放疗可通过低能X射线或加速电子束实施。本综述阐述了术中放疗最主要的临床应用方向，并探讨了人工智能在克服当前技术局限方面的潜在优势。近数十年来，术中放疗已在多种癌症治疗中证实其有效性：在乳腺癌治疗中，可作为单次剂量的部分乳房照射或高危患者的追加照射；在局部进展期直肠癌治疗中，对瘤床的单次照射能改善局部控制率，预防原发及复发肿瘤的盆腔转移；在肉瘤治疗中，尤其对腹膜后及四肢肿瘤，可实现高剂量照射并获得良好功能预后与低毒性；在胰腺癌治疗中，对临界可切除及不可切除病例展现出良好前景。持续发展的技术革新正在应对当前影像学与放疗规划领域的挑战，为个性化影像引导的术中放疗开辟道路。配备CT与MRI的复合手术室等创新技术实现了实时成像，为人工智能辅助的靶区勾画与治疗规划创造条件。此外，机器学习、深度学习及影像组学等人工智能技术的应用，可提升影像解读能力、预测治疗效果并优化工作流程效率。
肿瘤(癌症)患者之家