Prospects and Disadvantages of Intraoperative Radiotherapy: A Systematic Review

Objectives: The primary objective of this systematic review was to evaluate the efficacy, safety, and limitations of intraoperative radiotherapy (IORT) across different cancer types, with a focus on breast and head and neck cancers. The aim was to compare IORT with other radiotherapy techniques and assess its benefits and drawbacks in oncological settings. Methods: Eligibility criteria included clinical trials, meta-analyses, and systematic reviews involving at least 15 participants, focusing on the efficacy and safety of IORT in comparison to other radiotherapy methods. The literature search was conducted in Web of Science, Scopus, and PubMed databases using predefined keywords. A total of 60 studies were initially identified, with 44 meeting the inclusion criteria. The risk of bias was assessed using standardized tools, including the Cochrane Risk of Bias Tool for randomized studies. A qualitative synthesis was performed, integrating data on local control (LC), overall survival (OS), recurrence rates, and treatment-related complications. Results: Of the 60 studies identified, 46 were included in the final analysis. These studies focused on various cancers, with a particular emphasis on breast cancer and head and neck cancer. The synthesis revealed that IORT offers several benefits, such as reduced treatment time and better local control in specific patient populations. However, there were inconsistencies in outcomes depending on the radiation technique used, and long-term follow-up data were often lacking. Conclusion: The evidence is limited by study heterogeneity, potential bias, and the absence of long-term data in some cases. While IORT demonstrates promising results, particularly in terms of reducing treatment duration and preserving healthy tissue, further high-quality studies are needed to strengthen the evidence base and clarify the long-term outcomes of IORT in different oncological settings.