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Efficacy and safety of intraoperative radiotherapy in rectal cancer: A systematic review and meta-analysis

Authors
  • Liu, Bin
  • Ge, Long
  • Wang, Jing
  • Chen, Ya-Qiong
  • Ma, Shi-Xun
  • Ma, Pei-Lan
  • Zhang, Yun-Qiang
  • Yang, Ke-Hu
  • Cai, Hui
Type
Published Article
Journal
World Journal of Gastrointestinal Oncology
Publisher
Baishideng Publishing Group Inc
Publication Date
Jan 15, 2021
Volume
13
Issue
1
Pages
69–86
Identifiers
DOI: 10.4251/wjgo.v13.i1.69
PMID: 33510850
PMCID: PMC7805273
Source
PubMed Central
Keywords
License
Green

Abstract

BACKGROUND In recent years, intraoperative radiotherapy (IORT) has been increasingly used for the treatment of rectal cancer. However, the efficacy and safety of IORT for the treatment of rectal cancer are still controversial. AIM To evaluate the value of IORT for patients with rectal cancer. METHODS We searched PubMed, Embase, Cochrane Library, Web of Science databases, and conference abstracts and included randomized controlled trials and observational studies on IORT vs non-IORT for rectal cancer. Dichotomous variables were evaluated by odds ratio (OR) and 95% confidence interval (CI), hazard ratio (HR) and 95%CI was used as a summary statistic of survival outcomes. Statistical analyses were performed using Stata V.15.0 and Review Manager 5.3 software. RESULTS In this study, 3 randomized controlled studies and 12 observational studies were included with a total of 1460 patients, who are mainly residents of Europe, the United States, and Asia. Our results did not show significant differences in 5-year overall survival (HR = 0.80, 95%CI = 0.60-1.06; P = 0.126); 5-year disease-free survival (HR = 0.94, 95%CI = 0.73-1.22; P = 0.650); abscess (OR = 1.10, 95%CI = 0.67-1.80; P = 0.713), fistulae (OR = 0.79, 95%CI = 0.33-1.89; P = 0.600); wound complication (OR = 1.21, 95%CI = 0.62-2.36; P = 0.575); anastomotic leakage (OR = 1.09, 95%CI = 0.59-2.02; P = 0.775); and neurogenic bladder dysfunction (OR = 0.69, 95%CI = 0.31-1.55; P = 0.369). However, the meta-analysis of 5-year local control was significantly different (OR = 3.07, 95%CI = 1.66-5.66; P = 0.000). CONCLUSION The advantage of IORT is mainly reflected in 5-year local control, but it is not statistically significant for 5-year overall survival, 5-year disease-free survival, and complications.

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