Don,

It's more involved, complicated than just that, and it's done only in a few select places, and each part of the trained team is integral for successfull outcome to do the 4 part process, 1. Radical resection, 2. reconstruction like a flap, 3. IORT, and 4. boost dose radiation by IMRT, Protons, and possibly chemo to follow. IORT is EBRT, external beam radiation, basically a newer form of brachtherapy, and like IMRT there are different types, and different radiation machines. There is IOERT, Intrabeam-IORT, Low -Dose IORT, and High Dose Rate-IORT that I know of. I did HD-IORT, where I receved one large dose of Radiation in one fraction, 10-20Gy, taking anywhere from 10-60 minutes using Photons, and is done with the maximum resection, reconstruction by the ENT. The RO has to select the dosage, which is already pre-planned, but final adjustments are made, and recalculated. The proper sized silcone radiation applicators is selected by the RO, placed, molded directly on the tumor bed, during neck exposure, sutured in place, packed, and organs clamped out of the radiation field, and or protected by molded lead. Each part of the team is responsible for certain aspects, for example, the physicist, has to do safety checks 24hrs before surgery so the after loader can deliver photon radiation to the HDR, and continioulu checks it during surgery. The RO, who is on the facility license, is responsible for the applicators, wire, monitoring the tumor bed, tumor dose, etc, along with the ENT, and the ENT is overall in charge of the surgery. The whole team leaves the OR to the sterile control room where the same life monitoring equipment is inside the lead shielded room for the anesthesiologist, ENT, Radiation Oncologist, Physacist, and use CCTV. The treatment plan is recalculated, and after verification with the Physacist, and RO, the RO delivers the radiation, and monitors the surgical bed, applicators with the ENT. After the radiation deliver, it is retracted, and Geiger counter used by the physicalist to enter the room, where the radiation applicators are removed from the tumor bef by the RO, physicist removes the portable HDR, cleans, secures it, and ENT completes the surgery. Then, about 6 weeks later, or confining the treatment package to under 100 days, a boost dose of EXBRT is done. I had IMRT for 5 weeks at 45Gy with Taxotere and Erbitux, and this year haf my carotid artery, and vegus nerve, tumor removed, and then did 5 weeks Proton Therapy at 50Gy with Carboplatin.

The RO Fellow said I was probably one of the few in the country to have had HD-IORT and Proton Therapy as part of the treatment package.