Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2021; 13(1): 69-86
Published online Jan 15, 2021. doi: 10.4251/wjgo.v13.i1.69
Efficacy and safety of intraoperative radiotherapy in rectal cancer: A systematic review and meta-analysis
Bin Liu, Long Ge, Jing Wang, Ya-Qiong Chen, Shi-Xun Ma, Pei-Lan Ma, Yun-Qiang Zhang, Ke-Hu Yang, Hui Cai
Bin Liu, Ya-Qiong Chen, Shi-Xun Ma, Pei-Lan Ma, Yun-Qiang Zhang, Gansu Provincial Hospital, General Surgery Clinical Medical Center, Lanzhou 730000, Gansu Province, China
Long Ge, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, Gansu Province, China
Jing Wang, Gansu University of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Ke-Hu Yang, Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China
Hui Cai, General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Author contributions: Liu B, Ge L, Yang KH, and Cai H designed the research; Liu B, Wang J, Chen YQ, Ma SX, and Ma PL conducted the literature search; Liu B and Ge L collected and retrieved the data; Liu B, Zhang YQ, and Wang YF analyzed the data; Liu B wrote and revised the manuscript; All authors approved the final version.
Supported by Natural Science Foundation of Gansu Province, China, No. 18JR3RA052; Gansu Province Da Vinci robot high end diagnosis and treatment personnel training project; National Key Research and Development Program Task Book, No. 2018YFC1311506; Lanzhou Talent Innovation and Entrepreneurship Project Task Contract, No. 2016-RC-56; 2019 Graduate Innovation Fund Project, No. 2020CX50.
Conflict-of-interest statement: No conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Cai, MD, PhD, Chief Doctor, Director, Professor, Surgical Oncologist, General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China. caialonteam@163.com
Received: November 10, 2020
Peer-review started: November 10, 2020
First decision: November 30, 2020
Revised: December 6, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: January 15, 2021
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.

Keywords: Intraoperative radiotherapy, Rectal cancer, Systematic review, External beam radiation therapy, Randomized controlled trials, Meta-analysis

Core Tip: Rectal cancer is one of the malignant tumors with a high fatality rate in the world. Intraoperative radiotherapy (IORT) allows for direct administration of high-dose radiation and the area that is at the greatest risk after resection. Although research reports on IORT for rectal cancer have been published, there is still a lack of reliable evidence regarding treatment efficacy and safety. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of IORT for the treatment of rectal cancer.