Evidence map›Paper›PMID 41001752›Full record

ArticleJournal of surgical oncology2025

The Impact of Intraoperative Radiotherapy on Margin Positive Locally Advanced Rectal Cancer: A Propensity-Matched Analysis of The National Cancer Database.

Metincan Erkaya, Salih Karahan, Mustafa Oruc, Sudha R Amarnath, Jacob A Miller, Ali Alipouriani, Brogan Catalano, Scott Steele, Emre Gorgun

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Metincan ErkayaDepartment of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA.ORCID https://orcid.org/0000-0002-4707-6059
Salih KarahanDepartment of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA.
Mustafa OrucDepartment of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA.
Sudha R AmarnathDepartment of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA.
Jacob A MillerDepartment of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA.
Ali AlipourianiDepartment of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA.
Brogan CatalanoDepartment of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA.
Scott SteeleDepartment of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA.
Emre GorgunDepartment of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA.

Funding

The authors received no specific funding for this work.
6 · The paper itself

Abstract

purposeIntraoperative radiotherapy (IORT) is utilized as an adjunctive treatment in advanced rectal cancer, particularly in cases with threatened surgical margins. Although IORT has shown benefits in enhancing local tumor control, its impact on overall survival (OS) remains unclear. This study assesses the effect of IORT on survival outcomes using a large cohort from the National Cancer Database (NCDB) and examines factors influencing its application in clinical practice across the United States.

methodsThe National Cancer Database was retrospectively reviewed (2006-2019) to identify patients with pathological T3-T4, M0 rectal cancer who underwent surgery following neoadjuvant chemotherapy. Patients with microscopically residual margin-positive were included and categorized into two groups: those who received neoadjuvant radiotherapy (RT) and those treated with intraoperative radiotherapy (IORT) combined with adjuvant/neoadjuvant RT. Groups were propensity score-matched (1:4) to balance baseline characteristics. The primary outcome was 5-year overall survival (OS), assessed using Kaplan-Meier analysis and Cox proportional hazards modeling.

resultsAmong 1,788 patients with margin-positive rectal cancer, IORT was administered to 119 patients (6.7%) while 1,669 patients (93.3%) received neoadjuvant RT. Patients receiving IORT were younger, more likely to have private insurance, more frequently treated at academic/research programs, and more commonly underwent pelvic exenteration and Multiagent chemotherapy. After propensity score matching, 119 IORT patients were compared with 476 neoadjuvant RT patients. IORT was associated with lower mortality in univariate analysis (HR: 0.63; p < 0.001); however, this benefit was attenuated after adjusting for confounders (HR: 0.84; p = 0.07). The 5-year overall survival rates were 58.4% for IORT versus 54.9% for neoadjuvant RT alone (p = 0.18).

conclusionThis nationwide analysis suggests that adding IORT to treatment does not significantly improve overall survival in margin-positive rectal cancer patients. However, due to heterogeneity in patient selection and dosing, further prospective trials are warranted to clarify its clinical role.

Indexed as

Intraoperative CareMargins of ExcisionRectal NeoplasmsAgedDatabases, FactualFemaleFollow-Up StudiesHumansMaleMiddle AgedNeoadjuvant TherapyPropensity ScoreRadiotherapy, AdjuvantRetrospective StudiesSurvival RateUnited Statesintraoperative radiotherapyNational Cancer Databaseneoadjuvantrectal cancer

Identifiers

PMID41001752
PMCPMC12579357

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.