(282) Intraoperative Radiation Therapy: A Systematic Review and Meta Analysis

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Presenting Author(s)

Rachel B. Fenberg

Medical Student
Albert Einstein College of Medicine
Bronx, New York, United States

Author(s)

Sarah C. Nyirjesy, MD

Resident Physician
Ohio State University Hospital Program
Columbus, Ohio, United States
Michael M. Li, MD

Resident Physician
Ohio State University - Department of Otolaryngology
Columbus, Ohio, USA
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mustafa bulbul, MD

West Virginia University, USA

Senior Author(s)

SP

Sidharth Puram, MD, PhD

Washington University School of Medicine, USA

Disclosure(s):

Rachel B. Fenberg: No relevant relationships to disclose.

Sarah C. Nyirjesy, MD: No relevant relationships to disclose.

Introduction: Intraoperative radiation therapy (IORT) is a treatment modality for head and neck cancer, typically used for local recurrence or gross residual disease. We completed a systematic review and meta-analysis to examine treatment patterns and patient outcomes for IORT administered to treat head and neck cancers.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We extracted survival probabilities and percent complications and performed a meta-analysis of proportions. Heterogeneity was assessed using I2. The random effects model was used to pool proportions from included studies.

Results: 2-year disease free survival (DFS) and overall survival (OS). Eight studies reported 2-year DFS and OS. The pooled 2-year DFS was 48% (95% CI=0.37-0.60). The pooled 2-year OS was 45% (95% CI=0.37-0.53). There was significant heterogeneity noted, I2=81.73% and I2=62.43%, respectively.

Twelve studies reported percent complications. The pooled proportion of complications for patients undergoing IORT was 23% (95% CI=0.17-0.30). There was significant heterogeneity noted as well, I2=78.81%.

The source of heterogeneity could not be further investigated given the paucity of information to perform further analysis.

Conclusions: The 2-year OS found in our study is less than what is reported in the literature for squamous cell carcinoma, the most common histology in our review and analysis. However, the patient population receiving IORT typically has advanced and invasive disease, making it difficult to conclude what benefit IORT truly had on their outcomes.

There is no consensus in the literature on the extent of benefits from IORT. The significant heterogeneity in our systematic review is evidence that there are conflicting results on the impacts of IORT. While there is potential for IORT to create local control and help lead to DFS, further studies are needed to clarify how IORT can be most beneficial for patients.