title: Safety, effectiveness and economic evaluation of intra-operative radiation therapy: a systematic review.
abstract: BACKGROUND
  Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy.
  
  
  METHODS
  The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. RESULTS from studies were analyzed and discussed within a descriptive synthesis.
  
  
  RESULTS
  Sixteen studies met the inclusion criteria. It seems that outcomes from using intraoperative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications; and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer.
  
  
  CONCLUSIONS
  According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology.
authors.affiliation: Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran. drnajafipour2002@yahoo.com.
authors.forename: Farshad
authors.initials: F
authors.lastname: Najafipour
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. pejman.hamouzadeh@gmail.com.
authors.forename: Pejman
authors.initials: P
authors.lastname: Hamouzadeh
authors.affiliation: Health Management and Economics Research Center, Iran University of Medical Sciences & Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. arabloo_j64@yahoo.com.
authors.forename: Jalal
authors.initials: J
authors.lastname: Arabloo
authors.affiliation: Young Researches and Elites Club, Science and Research Branch, Islamic Azad University, Tehran, Iran. mobinreza@yahoo.com.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Mobinizadeh
authors.affiliation: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. dr.a.norozi@gmail.com.
authors.forename: Amir
authors.initials: A
authors.lastname: Norouzi
keywords: Cancer; Health Technology Assessment; IORT; Intra-Operative Radiation Therapy