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

Table 3 Results of meta-analysis and subgroup analysis by intraoperative radiotherapy compared with non-intraoperative radiotherapy for rectal cancer

Outcome indicators	Study type	NO of study	Patients, n IORT non-IORT	HR/OR/WMD (95% CI)	P value	Heterogeneity, χ2/ I2/ P value
5-yr overall survival	RCT	3	129 95	0.68 (0.29-1.63)	0.390	2.92/31.4%/0.233
	Observational studies	6	321 292	0.81 (0.66-1.11)	0.189	2.21/0.0%/0.819
	Totality	9	450 387	0.80 (0.60-1.06)	0.126	5.16/0.0%/0.740
5-yr disease free survival	RCT	2	91 57	1.61 (0.74-3.53)	0.231	0.60/0.0%/0.440
	Observational studies	4	235 212	0.89 (0.68-1.16)	0.374	1.72/0.0%/0.633
	Totality	6	326 269	0.94 (0.73-1.22)	0.650	4.33/0.0%/0.503
5-yr local control	RCT	3	129 95	1.37 (0.35-5.35)	0.655	1.33/24.8%/0.249
	Observational studies	11	487 511	3.38 (1.73-6.57)	0.000	41.31/73.4%/0.000
	Totality	14	616 606	3.07 (1.66-5.66)	0.000	43.42/70.9%/0.000
Abscess	RCT	2	57 60	1.83 (0.65-5.11)	0.252	0.01/0.0%/0.905
	Observational studies	4	205 262	0.94 (0.53-1.66)	0.833	1.99/0.0%/0.575
	Totality	6	262 322	1.10 (0.67-1.80)	0.713	3.22/0.0%/0.665
Fistulae	RCT	1	72 68	0.75 (0.30-1.88)	0.542	0.00/NA/NA
	Observational studies	2	94 175	1.22 (0.08-18.77)	0.888	2.02/50.4%/0.156
	Totality	3	166 243	0.79 (0.33-1.89)	0.600	2.07/3.2%/0.356
Wound complications	RCT	1	72 68	0.75 (0.30-1.88)	0.542	0.00/NA/NA
	Observational studies	7	385 393	1.06 (0.47-2.37)	0.893	16.09/62.7%/0.013
	Totality	8	457 461	1.21 (0.62-2.36)	0.575	17.01/58.8%/0.017
Anastomotic leakage	RCT	3	129 95	2.18 (0.89-5.33)	0.087	0.11/0.0%/0.946
	Observational studies	4	262 266	0.66 (0.31-1.41)	0.283	2.46/0.0%/0.482
	Totality	7	391 361	1.09 (0.59-2.02)	0.775	6.57/8.7%/0.363
Neurogenic bladder dysfunction	Observational studies	3	187 197	0.69 (0.31-1.55)	0.369	0.27/0.0%/0.874

HR: Hazard ratio; IORT: Intraoperative radiotherapy; NA: Not reported; non-IORT: Non-Intraoperative radiotherapy; OR: Odds ratio; RCT: Randomized controlled trial; WMD: Weighted mean difference.