Integrating Intraoperative Radiotherapy: Workflow, Quality Assurance, and Clinical Implementation

Intraoperative radiotherapy (IORT) has emerged as a valuable technique in the multidisciplinary management of various malignancies, including breast, colorectal, pancreatic, gynecologic, and soft tissue sarcoma. By delivering a concentrated dose of radiation directly to the tumor bed during surgery, IORT offers potential advantages over conventional external beam radiotherapy (EBRT): reduced treatment duration, decreased hospital visits, and improved quality of life for selected patients. Landmark trials such as TARGIT-A and ELIOT have established IORT as a viable option in early breast cancer, while expanding evidence supports its role in other disease sites. However, despite growing clinical experience, practical challenges remain in translating this evidence into widespread, standardized practice.This Research Topic aims to bridge the gap between clinical evidence and real-world implementation of IORT. While outcome data continue to mature, key questions persist around optimizing workflows, ensuring robust quality assurance, defining patient selection criteria, and establishing training pathways for multidisciplinary teams. Additionally, comparative data on IORT versus EBRT across different disease sites, cost-effectiveness analyses, and long-term safety reporting remain underrepresented in the literature. By uniting experts from radiation oncology, surgery, medical physics, and health services research, this collection seeks to provide a practical, evidence-based roadmap for institutions seeking to establish or refine their IORT programs.We welcome original research, systematic reviews, technical reports, expert perspectives, and case series addressing the following themes:• Implementation strategies and workflow optimization for IORT programs across disease sites.• Quality assurance, standardization, and dosimetry for low-energy X-ray (e.g., Intrabeam) and electron beam IORT systems.• Comparative outcome studies of IORT versus EBRT: recurrence, survival, toxicity, and patient-reported outcomes.• Patient selection criteria, risk stratification, and multidisciplinary decision-making.• IORT applications beyond breast cancer: colorectal, pancreatic, gynecologic, and soft tissue sarcoma.• Training, credentialing, and multidisciplinary team development for sustainable IORT services.• Cost-effectiveness and health economic analyses of IORT compared to conventional radiotherapy.• Institutional experiences and lessons learned in establishing IORT programs.• Long-term safety, adverse event reporting, and risk mitigation strategies.• Emerging technologies: novel applicators, image-guided IORT, and investigational approaches such as FLASH-IORT.Submissions should emphasize clinical or translational relevance and practical applicability. Case series illustrating implementation challenges, novel applications, or outcomes in underrepresented patient populations are particularly encouraged. By pooling contemporary expertise and data, this collection aims to support the safe, effective, and equitable integration of IORT into modern oncology practice.Please note: Manuscripts consisting solely of bioinformatics, computational analysis, or predictions from public databases without independent clinical, patient cohort, or biological validation are not suitable for publication in this journal. Topic editors: Elvira V Grigorieva, James M. Brindle, Dalong Pang, Jayant Sharad Vaidya Source: https://www.frontiersin.org/research-topics/82845/integrating-intraoperative-radiotherapy-workflow-quality-assurance-and-clinical-implementation