Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD): An international systematic review and meta-analysis

Diana Lin, Eric J. Lehrer, Jennifer Rosenberg, Daniel M. Trifiletti, Nicholas Zaorsky

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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.

Original languageEnglish (US)
Pages (from-to)147-152
Number of pages6
JournalRadiotherapy and Oncology
Volume135
DOIs
StatePublished - Jun 1 2019

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Meta-Analysis
Radiotherapy
Collagen Diseases
Vascular Diseases
Inflammatory Bowel Diseases
Incidence
Therapeutics
PubMed
MEDLINE
Sample Size
Comorbidity
Confidence Intervals
Neoplasms

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{d0ef9ab5c294432b84a1348a66bf24ed,
title = "Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD): An international systematic review and meta-analysis",
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.",
author = "Diana Lin and Lehrer, {Eric J.} and Jennifer Rosenberg and Trifiletti, {Daniel M.} and Nicholas Zaorsky",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.radonc.2019.03.006",
language = "English (US)",
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journal = "Radiotherapy and Oncology",
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T1 - Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD)

T2 - An international systematic review and meta-analysis

AU - Lin, Diana

AU - Lehrer, Eric J.

AU - Rosenberg, Jennifer

AU - Trifiletti, Daniel M.

AU - Zaorsky, Nicholas

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

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