in the treatment of high-risk patients with locally advanced primary or locally recurrent cancers. Gynecological cancer Studies suggest that electron IORT may play an important and useful role in the treatment of patients with locally advanced and recurrent gynecologic cancers, especially for patients with locally recurrent cancer after treatment for their primary lesion. Further research into radiation doses and how to best combine IOERT with other interventions will help to define the sequencing of treatment and the patients who would most benefit from receiving electron IORT, as part of the multimodality treatment of this disease. Head and neck cancer Head and neck cancers are often difficult to treat and have a high rate of recurrence or metastasis. IOERT is an effective means of treating locally advanced or recurrent head and neck cancers. Furthermore, research shows that a boost given by IOERT reduces the ability for surviving tumor cells to replicate, creating extra time for healing of the surgical wound before EBRT is administered. Pancreatic cancer In the U.S., pancreatic cancer is the fourth leading cause of cancer death, even though there has been a slight improvement in mortality rates in recent years. Although the optimal treatment plan remains debated, a combination of radiotherapy and chemotherapy is favored in the U.S. As part of a multimodality treatment, IOERT appears to reduce local recurrence when combined with EBRT, chemoradiation, and surgical resection. Soft tissue sarcomas Soft tissue sarcomas can be effectively treated by electron IORT, which appears to be gaining acceptance as the current practice for sarcomas in combination with EBRT (preferably preoperative) and maximal resection. Used together, IOERT and EBRT appear to be improving local control, and this method is being refined so that it can effectively be used in combination with other interventions if indicated. In studies regarding the delivery of therapeutic radiation in the limb-sparing approach to extremity soft tissue sarcomas, electron IORT has been called ‘precision radiotherapy’ by some, because the treating physician has direct visualization of the tumor or surgical cavity and can manually exclude normal tissue from the field. History Spanish and German doctors, in 1905 and 1915 respectively, used intraoperative radiation therapy (IORT) in an attempt to eradicate residual tumors left behind after surgical resection. However, radiation equipment in the early twentieth-century could only deliver low energy X-rays, which had relatively poor penetration; high doses of radiation could not be applied externally without doing unacceptable