Intraoperative radiation therapy (IORT) has been used in the treatment of locally advanced and recurrent rectal cancers for the last several decades. Given the heterogeneity of patients treated and different indications for use and dosing at different institutions, it has been difficult to discern if IORT adds any appreciable benefit to standard of care therapies. Herein, the rationale for IORT in rectal cancer is discussed along with the most modern and best available data in 2023. IORT is likely indicated in patients with locally advanced and locally recurrent rectal cancer with threatened margins (R0 or R1 resection) to help improve local control. High-quality imaging and multidisciplinary discussion are necessary to ensure optimal patient selection. Appropriate counseling of the patient and excellent team communication are of the utmost importance given the challenging nature of these cases and the prognostic implications of R1 and R2 resections in this patient population.

过去几十年来，术中放射治疗（IORT）一直用于治疗局部晚期和复发性直肠癌。考虑到接受治疗的患者的异质性以及不同机构使用和剂量的不同适应症，很难辨别 IORT 是否为标准护理治疗带来了任何明显的益处。本文讨论了直肠癌 IORT 的基本原理以及 2023 年最现代和最佳的可用数据。IORT 可能适用于边缘受威胁（R0 或 R1 切除）的局部晚期和局部复发直肠癌患者，以帮助改善局部控制。高质量的成像和多学科讨论对于确保最佳的患者选择是必要的。