Causes for Radiation Oncology Surgery

Radiation oncology surgery, often referred to as radiation therapy or radiotherapy, plays a vital role in the treatment of various cancers. This specialized form of treatment uses high-energy radiation to kill or shrink cancer cells. While radiation therapy is non-invasive, it may sometimes be paired with surgery or delivered during surgery (intraoperative radiation therapy). But what are the actual causes or reasons that lead doctors to recommend radiation oncology surgery?

Unlike traditional surgery, which physically removes tumors through incisions, radiation therapy is typically non-invasive. It can be used on its own or in combination with other treatments, such as surgery or chemotherapy, depending on the type and stage of cancer. In some cases, radiation is administered before surgery to shrink tumors, making them easier to remove. In other situations, it’s used after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. A more advanced approach, known as intraoperative radiation therapy (IORT), allows radiation to be delivered directly to the tumor site during surgery, ensuring maximum impact while limiting exposure to healthy tissues.

What Is Radiation Oncology Surgery?

Radiation oncology surgery combines the precise use of radiation with surgical techniques to treat cancer. It may involve :-

1. Preoperative radiation therapy :- given before surgery to shrink tumors.

2. Intraoperative radiation therapy (IORT) :- delivered during surgery.

3. Postoperative radiation therapy :- used after surgery to eliminate remaining cancer cells.

Radiation oncology specialists carefully plan the treatment to target tumors while minimizing damage to healthy tissues.

Top Causes for Radiation Oncology Surgery

Tumor Shrinkage Before Surgery

One of the most common reasons for recommending radiation therapy before surgery is to shrink large tumors. Certain cancers, such as rectal, esophageal, or sarcomas, may be too large or risky to remove safely through surgery alone. Radiation can reduce tumor size, making surgical removal easier and less invasive.

Example :- In rectal cancer, radiation is often given before surgery to improve the likelihood of complete tumor removal and preserve sphincter function.

Residual Cancer Cells After Surgery

Radiation therapy is frequently used after surgical tumor removal to target any microscopic cancer cells that may remain. Even if a tumor appears to be completely removed, small clusters of cancer cells may still linger. Radiation can help destroy these and prevent cancer recurrence.

Example :- In breast cancer, radiation therapy is often prescribed after lumpectomy to reduce the risk of the cancer coming back in the same area.

Inoperable or Hard-to-Reach Tumors

Some tumors are located in areas that are difficult or dangerous to operate on such as the brain, spine, or lungs. In such cases, radiation oncology surgery becomes the primary treatment. High-precision radiation techniques like stereotactic radiosurgery (SRS) can deliver focused radiation to these regions without open surgery.

Example :- Brain metastases from lung cancer are often treated with SRS instead of traditional brain surgery.

Preservation of Organ Function

For cancers located near vital organs or in sensitive structures, radiation may be preferred over full surgical removal to preserve function. This is especially relevant in head and neck cancers, prostate cancer, or cervical cancer, where surgery could result in significant loss of function or quality of life.

Example :- In laryngeal cancer, radiation may be chosen over surgery to help preserve the patient’s voice.

Palliative Treatment for Symptom Relief

In advanced-stage cancers, radiation therapy is often recommended to relieve symptoms like pain, bleeding, or obstruction even if the cancer is not curable. This type of treatment is known as palliative radiation and can significantly improve a patient’s comfort and quality of life.

Example :- Radiation can help shrink bone metastases to relieve pain and reduce the risk of fractures.

Cancer Recurrence After Surgery

If cancer returns after initial treatment, radiation therapy may be recommended either alone or with further surgery. In some cases, previously untreated areas may now require radiation due to recurrence or progression.

Example :- In prostate cancer recurrence, radiation is often used after prostatectomy to treat the prostate bed or pelvic lymph nodes.

High-Risk Surgical Margins

When surgeons remove a tumor but find that the margins are not clear (i.e., cancer cells are found at the edge of the removed tissue), radiation therapy may be prescribed to target potential remaining cells and reduce the risk of recurrence.

Example :- In soft tissue sarcoma, if surgical margins are positive or close, radiation is used postoperatively.

Combination with Chemotherapy (Chemoradiation)

Some cancers respond best to a combination of radiation and chemotherapy, especially when surgery isn’t possible. This dual approach, known as chemoradiation, can be curative in certain types of cancers such as anal cancer, cervical cancer, oropharyngeal cancers, and more.

Example :- In cervical cancer, concurrent chemoradiation may replace surgery altogether as the primary treatment.

Types of Radiation Oncology Surgery Techniques

Different cancers and causes call for different types of radiation delivery techniques. These include:

External Beam Radiation Therapy (EBRT) :-

The most common method, where beams of radiation are directed from outside the body.

Brachytherapy :-

Internal radiation where radioactive seeds are placed directly inside or near the tumor.

Stereotactic Radiosurgery (SRS) :-

A high-precision technique often used for brain and spine tumors.

Intraoperative Radiation Therapy (IORT) :-

Radiation delivered directly to the tumor site during surgery.

Cancers Commonly Treated with Radiation Oncology Surgery

Radiation therapy is used in the treatment of many types of cancer, including:

1. Breast cancer

2. Prostate cancer

3. Lung cancer

4. Head and neck cancers

5. Cervical and uterine cancers

6. Rectal and anal cancers

7. Brain tumors and metastases

8. Bone cancers and soft tissue sarcomas

The specific recommendation for radiation oncology surgery depends on cancer type, stage, location, and patient health.

When Is Radiation Oncology Surgery Not Recommended?

While radiation therapy is effective, it’s not suitable in all cases. Situations where it may not be used include:

1. Tumors that are highly resistant to radiation.

2. Previous exposure to radiation in the same area (due to cumulative dose limits).

3. Pregnancy, especially in the early stages.

4. Poor overall health making the patient unable to tolerate treatment side effects.

A multidisciplinary cancer team evaluates each case to decide whether radiation oncology surgery is appropriate.

Benefits of Radiation Oncology Surgery

1. Non-invasive or minimally invasive

2. Preserves organs and function

3. Effective against localized tumors

4. Can be combined with surgery and chemotherapy

5. Improves survival and quality of life

Conclusion

Radiation oncology surgery is a critical tool in the fight against cancer. Whether used before surgery to shrink tumors, after surgery to eliminate remaining cells, or as the primary treatment in inoperable cases, its causes are driven by medical necessity, patient safety, and treatment goals.

Patients undergoing radiation therapy benefit from a team-based approach, involving oncologists, surgeons, radiologists, and pathologists who tailor treatment to the individual’s condition. Understanding the reasons behind radiation therapy helps patients and families make informed decisions and approach treatment with clarity and confidence.