Background/Objectives:Intraoperative radiotherapy (IORT) has been used for decades to improve local control in advanced and recurrent head and neck cancers by delivering a concentrated dose of radiation directly to the tumor bed during surgery. Despite its potential advantages, IORT remains controversial due to its high complication rates and logistical complexity. This systematic review aims to assess the current evidence on IORT in head and neck oncology, evaluating its indications, effectiveness, and limitations.Methods:A systematic literature review was conducted in accordance with Cochrane systematic review method and reported following PRISMA guidelines. Databases, including Medline, Embase, Cochrane, and Web of Science, were searched for studies evaluating IORT in head and neck cancer. Outcomes of interest included local control rates, overall survival, complications, and treatment logistics. Data were weighted based on patient numbers, and statistical analyses included weighted means and comparative tests.Results:Included in this review are 47 studies that included 2330 patients. The studies were highly heterogeneous, limiting definitive conclusions. IORT was mainly used in stage III/IV or recurrent tumors, with an average dose of 14.7 Gy (range: 1–40 Gy). The five-year local control was 47% to 82%. Complication rates included wound necrosis (22,3%), fistulas 34 (17.8%), and carotid blow-out (14.5%). Logistical constraints remain a major limitation.Conclusions:The heterogeneous data and logistic challenges of IORT in head and neck oncology have limited its use, and the benefits remain uncertain.
背景/目的：术中放疗（IORT）已应用数十年，通过在手术期间直接向肿瘤床投送集中剂量的放射线，旨在提高晚期及复发性头颈癌的局部控制率。尽管具有潜在优势，但由于其高并发症率及操作复杂性，IORT仍存在争议。本系统性综述旨在评估头颈肿瘤学中IORT的现有证据，评价其适应症、有效性及局限性。 方法：按照Cochrane系统综述方法进行系统性文献回顾，并遵循PRISMA指南进行报告。检索了包括Medline、Embase、Cochrane和Web of Science在内的数据库，以查找评估IORT在头颈癌中应用的研究。关注的结果包括局部控制率、总生存率、并发症及治疗操作流程。数据根据患者数量进行加权，统计分析包括加权均值和比较检验。 结果：本综述纳入47项研究，共涉及2330名患者。研究间存在高度异质性，限制了明确结论的得出。IORT主要用于III/IV期或复发性肿瘤，平均剂量为14.7 Gy（范围：1–40 Gy）。五年局部控制率为47%至82%。并发症率包括伤口坏死（22.3%）、瘘管形成（17.8%）和颈动脉破裂（14.5%）。操作流程的限制仍是主要制约因素。 结论：头颈肿瘤学中IORT数据的异质性及操作挑战限制了其应用，其获益仍不确定。
肿瘤(癌症)患者之家