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Radiation oncology · London

IORT (intraoperative radiotherapy) - private in London.

A single, high-dose treatment delivered inside the tumour bed during surgery - Intrabeam for early breast cancer under the TARGIT-A protocol, and IOERT via a mobile linac for soft tissue sarcoma - in London centres with a high case volume and full MDT backup.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private IORT costs in London.

Indicative ranges across our partner centres.

In short

£8,500-£14,000, home the next day.

Procedure Indicative range
MDT review and IORT eligibility opinion £450-£850
Breast IORT (Intrabeam, single 20 Gy dose at lumpectomy) £8,500-£14,000
Breast IORT plus supplemental external beam course £13,500-£19,000
Sarcoma IOERT (mobile linac, retroperitoneal or extremity) £14,000-£22,000
Second-opinion review of prior plan and histology £300-£550

Prices vary by centre, by whether Intrabeam or a mobile electron linac is used, by additional external beam requirement, and by length of stay.

The problem

One dose in theatre, or fifteen visits over three weeks.

For carefully selected patients, a single 20 Gy dose delivered directly into the tumour bed at lumpectomy can replace the standard whole-breast external beam course. The trick is knowing who fits, and who does not.

  • Is IORT even the right treatment?

    A lobular, high-grade, HER2 positive or node-positive cancer should get external beam radiotherapy - not a single intra-operative dose.

  • Worried about needing more radiotherapy later?

    Around 15-20% of IORT patients need supplemental external beam once full histology is back. We plan for that up front.

  • Want it done in a specialist unit?

    A named breast surgeon and clinical oncologist, an Intrabeam or IOERT centre, and MDT backup for adjuvant therapy decisions.

When it helps

When IORT is the right step - and when it is not.

The TARGIT-A eligibility criteria in plain English, plus the pathology features that mean external beam radiotherapy is added or used instead.

  • Early invasive ductal breast cancer

    Screen-detected or symptomatic invasive ductal carcinoma under 3.5 cm, meeting TARGIT low-risk criteria.

  • Age over 45, node-negative

    Post-menopausal or peri-menopausal women with clinically and radiologically node-negative disease on ultrasound and MRI.

  • ER positive, HER2 negative

    Hormone-receptor positive, HER2 negative tumours behave predictably and match the biology TARGIT-A tested.

  • Grade 1 or 2, no lymphovascular invasion

    Well or moderately differentiated tumours without lymphovascular invasion on biopsy fit the low-risk profile.

  • As a boost on top of external beam

    For higher-risk tumours, IORT can replace the standard tumour-bed boost and shorten the external beam course.

  • Retroperitoneal or extremity soft tissue sarcoma

    IOERT via a mobile linac boosts the tumour bed at resection, sparing bowel and neurovascular structures.

  • When daily hospital visits are not realistic

    For patients who cannot commit to 15 to 25 daily radiotherapy visits, a single intra-operative dose is a genuine alternative.

  • Red flag: lobular, high-grade, HER2 positive, node-positive

    These features push you off the TARGIT pathway. External beam radiotherapy and systemic therapy come first.

Treatment options

IORT is a family of techniques - and external beam sits beside it.

What each option on the table actually involves - and which fits which cancer. For higher-risk features, we combine IORT with adjuvant external beam or use external beam alone.

  • Intrabeam TARGIT-A (breast, 20 Gy)

    A miniature 50 kV X-ray source with a spherical applicator sized to the cavity. Delivered inside the tumour bed at lumpectomy. The workhorse for early breast IORT.

  • Intrabeam TARGIT-B (boost)

    The same device used as an intra-operative boost in higher-risk patients who will also receive external beam radiotherapy afterwards.

  • IOERT (mobile linear accelerator)

    A wheeled electron linac used in the operating theatre for sarcoma, colorectal recurrence and selected pancreatic cases. Beam energies from 6 to 12 MeV.

  • HDR brachytherapy IORT

    A high-dose-rate iridium source guided into surface applicators laid over the tumour bed. An alternative to Intrabeam in some centres.

  • Whole-breast external beam radiotherapy

    The standard 15-fraction adjuvant course after breast conservation. IORT can replace it in selected TARGIT-eligible patients, or shorten it.

  • Partial-breast external beam (APBI)

    A 5 to 10 fraction course targeting only the tumour bed. An alternative to IORT for patients who prefer external beam or who need a second-look pathology first.

  • Second-opinion review

    A specialist review of your biopsy, MRI and MDT plan - sometimes the honest answer is external beam rather than IORT, or a different sequence altogether.

  • Combined IORT plus systemic therapy

    Endocrine therapy for ER-positive disease, chemotherapy or anti-HER2 therapy where indicated - planned alongside the radiotherapy decision, not after it.

Safety and recovery

What to expect afterwards - honestly.

IORT has been used in the UK for over fifteen years. The things worth planning are your general anaesthetic, wound healing, the chance of needing supplemental external beam, and long-term follow-up.

  • General anaesthetic, one night in hospital

    Breast IORT is delivered under the same anaesthetic as the lumpectomy. Most patients go home the day after surgery with routine wound care.

  • Wound healing and seroma

    A fluid collection in the cavity (seroma) is common after any breast conservation and usually settles without drainage. IORT does not increase this materially.

  • Skin and fat changes

    Skin fibrosis and fat necrosis rates are lower than after whole-breast external beam radiotherapy. Cosmetic outcomes in TARGIT-A were at least as good at 5 years.

  • Local recurrence risk

    TARGIT-A 2020 showed non-inferior local recurrence at 5 years for selected low-risk patients. Around 15-20% of IORT patients need supplemental external beam once full histology is back.

  • Lung and heart dose

    Because the dose falls off within 1 cm of the applicator, the lung and (for left-sided tumours) the heart receive a fraction of the dose given by external beam.

  • Bowel and nerve sparing in sarcoma IOERT

    For retroperitoneal or pelvic sarcoma, IOERT lets the surgeon retract bowel out of the field and boost the tumour bed with a single electron dose.

  • Endocrine and systemic therapy still apply

    IORT replaces or reduces radiotherapy - not tamoxifen, aromatase inhibitors or chemotherapy where these are indicated by biology.

  • Follow-up mammography

    Annual mammograms remain the standard. The IORT scar can look denser on early films - the radiologist reviewing your images should know IORT was used.

  • Red flags after discharge

    Spreading redness, fever, uncontrolled pain, wound breakdown or a sudden collection - call the unit or go to A&E the same day.

Reading your IORT report

Your IORT report in four parts. Read the last one first.

Whichever centre you go to, the report the surgeon and clinical oncologist sends keeps to the same shape.

A London breast clinical oncologist reviewing an IORT plan

A quiet reminder

Radiotherapy language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the report before your review, just ask.

  1. 01 Header

    Tumour size, grade and receptor status

    Invasive size in millimetres, histological type (ductal, lobular), grade 1-3, ER, PR and HER2 status, and lymphovascular invasion.

  2. 02 Technique

    Applicator size, dose and duration

    Intrabeam applicator diameter, prescribed dose (typically 20 Gy at the applicator surface), and irradiation time from source-in to source-out.

  3. 03 Findings

    Margins, node status and completeness

    Whether resection margins are clear, sentinel node result, and the oncologist and surgeon judgement on whether external beam should be added.

  4. 04 Impression

    Adjuvant plan and follow-up interval

    Read this first: whether supplemental external beam is recommended, endocrine or chemotherapy plan, and when your next clinic and mammogram are booked.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for IORT varies by insurer and by indication - usually funded when medically indicated.

Frequently asked

Everything we get asked about IORT.

Quick answers on eligibility, insurance, MDT sign-off, cosmesis and the risk of needing more radiotherapy.

  • Does IORT completely replace external beam radiotherapy?

    For carefully selected patients meeting the TARGIT-A low-risk criteria - age over 45, invasive ductal, under 3.5 cm, node-negative, grade 1 or 2, ER positive and HER2 negative - a single 20 Gy Intrabeam dose can replace the standard 15-fraction whole-breast external beam course. Around 15 to 20% of IORT patients need supplemental external beam once full histology is back, so it is planned as a risk-adapted approach rather than an absolute either-or.

  • Is IORT covered by private medical insurance?

    Most major UK insurers cover breast IORT and sarcoma IOERT when medically indicated and delivered at a recognised centre. Bupa, AXA, Vitality, Aviva, WPA and Cigna typically fund the additional theatre time and equipment, provided pre-authorisation and MDT documentation are in place.

  • Does an MDT review the case before IORT?

    Yes. Every IORT decision goes through a breast (or sarcoma) MDT with the surgeon, clinical oncologist, radiologist, pathologist and specialist nurse. The MDT confirms TARGIT-A eligibility, plans the systemic therapy alongside the radiotherapy, and agrees the threshold for adding external beam if histology upgrades the risk.

  • Can IORT be repeated if the cancer comes back?

    A local recurrence in a previously irradiated breast usually needs mastectomy rather than repeat conservation. Repeat IORT is technically possible in selected cases and has been reported for chest-wall recurrence, but it is a specialist decision made in an MDT with plastic surgery and systemic-therapy input.

  • What are the cosmetic results like?

    The TARGIT-A trial found cosmetic outcomes at 5 years to be at least as good as, and in some measures better than, whole-breast external beam radiotherapy. Because the dose falls off rapidly around the applicator, skin fibrosis and telangiectasia are less frequent. Fat necrosis can happen but is uncommon.

  • What are the side effects and how long do they last?

    The main early effects are those of any lumpectomy - bruising, seroma, tenderness and short-term fatigue - which settle over 2 to 4 weeks. Late radiotherapy effects such as skin firmness or breast shrinkage are less than after external beam. Lung and heart doses are a fraction of external beam levels, which matters for left-sided tumours in particular.

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