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Benefits from adjuvant intraoperative radiotherapy treatment for gastric cancer: A meta-analysis.

The benefits of adjuvant intraoperative radiotherapy (IORT) for resectable gastric cancer have been extensively studied, but data on the survival rate remains equivocal. A meta-analysis was performed of the studies involving the use of IORT for resectable gastric cancer using web-based databases. Hazard ratios (HRs) describing the impact of adjuvant IORT on the overall survival (OS) rate and locoregional control were extracted directly from the original studies or calculated from survival curves. A meta-analysis of four studies that provided OS data revealed that IORT had no significant impact on OS [HR, 0.97; 95% confidence interval (CI), 0.75-1.26; P=0.837]. In the three studies testing the efficacy of IORT for OS in the subgroup of patients with stage III disease, there was a significantly improved OS (HR, 0.60; 95% CI, 0.40-0.89; P=0.011). Significant locoregional control improvement was observed in the four studies that provided locoregional control data (HR 0.40; 95% CI, 0.26-0.62; P<0.001). This meta-analysis showed a statistically significant locoregional control benefit with the addition of IORT in patients with resectable gastric cancer. In addition, the available data revealed that adjuvant IORT may provide promising results on the survival rate for the subgroup of patients with stage III disease. Further study is required to optimize the implementation of adjuvant IORT for gastric cancer with regard to patient selection and integration with systemic therapy.