Intraoperative electron radiotherapy (IOERT) in colorectal cancer: updated systematic review of techniques, oncological outcomes and complications
Intraoperative electron radiotherapy (IOERT) in colorectal cancer: updated systematic review of techniques, oncological outcomes and complications
Background: intra-operative electron radiotherapy (IOERT) directly delivers a large fraction of radiation to at-risk margins during surgery. However, the precise benefit of IOERT in patients with locally advanced and locally recurrent colorectal cancer (LACC/LRCC) is unclear. This study aimed to provide an updated summary of the current evidence available regarding IOERT as part of multi-modality treatment of LACC and LRCC.
Method: this systematic review update was prospectively registered on PROSPERO (CRD42023438184). An electronic literature search was carried out using Ovid (MEDLINE), EMBASE, Web of Science, and the Cochrane Library databases for studies from July 2011 to April 2024. The inclusion criteria were adult patients who received IOERT as part of multi-modal treatment for LACC or LRCC. The primary outcome was overall survival (OS), disease free survival (DFS) and local control (LC) at 5 years. Secondary outcomes included post-operative complications.
Results: 16 new studies were identified since the previous analysis, and included (study population 1912 patients) of which two were prospective. High heterogeneity prevented meta-analysis of outcomes except for 5-year OS which suggested a non-significant benefit favouring IOERT. Significant methodological concerns were identified making interpretations challenging, however patients with LACC or LRCC with an R1 resection margin showed a favourable 5-year OS (40 % and 18 % respectively) when compared to current evidence.
Conclusion: although limited by a lack of appropriately conducted randomised evidence, IOERT-containing multi-modality treatment may improve oncological outcomes in LACC and LRCC patients with R1 resections.
Tiwari, Abhinav
ac41bade-4864-42a9-aa6a-66b54449c930
Lee, Sheah Lin
73132638-fb25-413d-9a81-6040c37eb2c3
MacCabe, Tom
608fd880-978e-4be9-8a3d-21e93c143179
Woyton, Michal
baeed9eb-117b-41f0-89bd-ec9fc99c8e5c
West, Charles T.
f55ef5be-4040-4c3a-978e-d0ce1eaeb366
Micklethwaite, Rohan
571ddbd1-222e-445c-92e3-55aeadcced2e
Yano, Hideaki
8295e4c5-7b60-4b0b-8542-ddce5ac5c38b
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Mirnezami, Alex H.
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
28 February 2025
Tiwari, Abhinav
ac41bade-4864-42a9-aa6a-66b54449c930
Lee, Sheah Lin
73132638-fb25-413d-9a81-6040c37eb2c3
MacCabe, Tom
608fd880-978e-4be9-8a3d-21e93c143179
Woyton, Michal
baeed9eb-117b-41f0-89bd-ec9fc99c8e5c
West, Charles T.
f55ef5be-4040-4c3a-978e-d0ce1eaeb366
Micklethwaite, Rohan
571ddbd1-222e-445c-92e3-55aeadcced2e
Yano, Hideaki
8295e4c5-7b60-4b0b-8542-ddce5ac5c38b
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Mirnezami, Alex H.
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
Tiwari, Abhinav, Lee, Sheah Lin, MacCabe, Tom, Woyton, Michal, West, Charles T., Micklethwaite, Rohan, Yano, Hideaki, West, Malcolm A. and Mirnezami, Alex H.
(2025)
Intraoperative electron radiotherapy (IOERT) in colorectal cancer: updated systematic review of techniques, oncological outcomes and complications.
European Journal of Surgical Oncology, 51 (5), [109724].
(doi:10.1016/j.ejso.2025.109724).
Abstract
Background: intra-operative electron radiotherapy (IOERT) directly delivers a large fraction of radiation to at-risk margins during surgery. However, the precise benefit of IOERT in patients with locally advanced and locally recurrent colorectal cancer (LACC/LRCC) is unclear. This study aimed to provide an updated summary of the current evidence available regarding IOERT as part of multi-modality treatment of LACC and LRCC.
Method: this systematic review update was prospectively registered on PROSPERO (CRD42023438184). An electronic literature search was carried out using Ovid (MEDLINE), EMBASE, Web of Science, and the Cochrane Library databases for studies from July 2011 to April 2024. The inclusion criteria were adult patients who received IOERT as part of multi-modal treatment for LACC or LRCC. The primary outcome was overall survival (OS), disease free survival (DFS) and local control (LC) at 5 years. Secondary outcomes included post-operative complications.
Results: 16 new studies were identified since the previous analysis, and included (study population 1912 patients) of which two were prospective. High heterogeneity prevented meta-analysis of outcomes except for 5-year OS which suggested a non-significant benefit favouring IOERT. Significant methodological concerns were identified making interpretations challenging, however patients with LACC or LRCC with an R1 resection margin showed a favourable 5-year OS (40 % and 18 % respectively) when compared to current evidence.
Conclusion: although limited by a lack of appropriately conducted randomised evidence, IOERT-containing multi-modality treatment may improve oncological outcomes in LACC and LRCC patients with R1 resections.
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Accepted/In Press date: 22 February 2025
e-pub ahead of print date: 24 February 2025
Published date: 28 February 2025
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Local EPrints ID: 500483
URI: http://eprints.soton.ac.uk/id/eprint/500483
ISSN: 0748-7983
PURE UUID: 4f30e9c3-4a16-479c-b7ee-e3f296b37647
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Date deposited: 01 May 2025 16:41
Last modified: 22 Aug 2025 02:19
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Author:
Abhinav Tiwari
Author:
Tom MacCabe
Author:
Michal Woyton
Author:
Charles T. West
Author:
Rohan Micklethwaite
Author:
Hideaki Yano
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