Diana Lin1, Eric J Lehrer2, Jennifer Rosenberg3, Daniel M Trifiletti4, Nicholas G Zaorsky5. 1. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA. Electronic address: https://twitter.com/DianaLinMed. 2. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: https://twitter.com/EricLehrer. 3. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA. 4. Department of Radiation Oncology, Mayo Clinic Jacksonville, Jacksonville, FL, USA. Electronic address: https://twitter.com/DanTrifMD. 5. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA; Department of Public Health Sciences, Penn State College of Medicine. Electronic address: nicholaszaorsky@gmail.com.
Abstract
BACKGROUND AND PURPOSE: To investigate the incidence of radiotherapy-related acute and late toxicities among patients with pro-inflammatory comorbidities. MATERIAL AND METHODS: PICOS/PRISMA/MOOSE methods were used to identify studies on PubMed and MEDLINE, 1970-2018. The following were extracted: location, cancer, sample size, age, follow-up duration, medical contraindication, treatment, and toxicity. A weighted random effects model with the DerSimonian and Laird method was used in the meta-analysis. The primary endpoint was the grade ≥ 3 acute toxicity, and the secondary endpoint was late toxicity. RESULTS: There were 1137 articles screened and 18 included, assessing 621 patients. Among the 18 articles, 10 had collagen vascular disease (n = 417) and 8 had inflammatory bowel disease (n = 204). Median follow-up was 52.8 months. 457 patients received radiotherapy alone, and 153 received concurrent chemo-radiotherapy. The random effects estimate for incidence of grade ≥ 3 toxicity in collagen vascular disease patients (95% confidence interval) was 11.7% (5.4-19.6%) and 6.1% (1.4-12.6%) for acute and late toxicities, respectively. Incidence of grade ≥ 3 toxicity in inflammatory bowel disease patients was 14.0% (7.1-22.4%) and 10.2% (3.2-19.7%) for acute and late toxicities, respectively. Average grade 4 toxicity across both diseases was 1.5% and 4.5% for acute and late toxicities, respectively. Average grade 5 toxicity across both diseases was negligible (<1%). CONCLUSIONS: Patients with historically accepted contraindications to radiation therapy have a 10-15% risk of any grade ≥ 3 toxicity, <5% risk of grade 4 toxicity, and <1% risk for grade 5 toxicity, suggesting that collagen vascular disease and inflammatory bowel disease are not absolute contraindications to radiotherapy.
BACKGROUND AND PURPOSE: To investigate the incidence of radiotherapy-related acute and late toxicities among patients with pro-inflammatory comorbidities. MATERIAL AND METHODS: PICOS/PRISMA/MOOSE methods were used to identify studies on PubMed and MEDLINE, 1970-2018. The following were extracted: location, cancer, sample size, age, follow-up duration, medical contraindication, treatment, and toxicity. A weighted random effects model with the DerSimonian and Laird method was used in the meta-analysis. The primary endpoint was the grade ≥ 3 acute toxicity, and the secondary endpoint was late toxicity. RESULTS: There were 1137 articles screened and 18 included, assessing 621 patients. Among the 18 articles, 10 had collagen vascular disease (n = 417) and 8 had inflammatory bowel disease (n = 204). Median follow-up was 52.8 months. 457 patients received radiotherapy alone, and 153 received concurrent chemo-radiotherapy. The random effects estimate for incidence of grade ≥ 3 toxicity in collagen vascular diseasepatients (95% confidence interval) was 11.7% (5.4-19.6%) and 6.1% (1.4-12.6%) for acute and late toxicities, respectively. Incidence of grade ≥ 3 toxicity in inflammatory bowel diseasepatients was 14.0% (7.1-22.4%) and 10.2% (3.2-19.7%) for acute and late toxicities, respectively. Average grade 4 toxicity across both diseases was 1.5% and 4.5% for acute and late toxicities, respectively. Average grade 5 toxicity across both diseases was negligible (<1%). CONCLUSIONS:Patients with historically accepted contraindications to radiation therapy have a 10-15% risk of any grade ≥ 3 toxicity, <5% risk of grade 4 toxicity, and <1% risk for grade 5 toxicity, suggesting that collagen vascular disease and inflammatory bowel disease are not absolute contraindications to radiotherapy.
Authors: N Shaverdian; J Beattie; M Thor; M Offin; A F Shepherd; D Y Gelblum; A J Wu; C B Simone; M D Hellmann; J E Chaft; A Rimner; D R Gomez Journal: Ann Oncol Date: 2020-09-30 Impact factor: 32.976
Authors: Jesus E Juarez; Tahmineh Romero; Constantine A Mantz; Abigail Pepin; Nima Aghdam; Simeng Suy; Michael L Steinberg; Rebecca G Levin-Epstein; Nicholas G Nickols; Irving D Kaplan; Robert M Meier; Huong T Pham; Patrick W Linson; Robert L Hong; Mark K Buyyounouski; Hilary P Bagshaw; Donald B Fuller; Alan J Katz; Andrew Loblaw; Sean P Collins; Amar U Kishan Journal: Adv Radiat Oncol Date: 2021-08-28