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Journal of Biological Regulators and... 2021Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year... (Meta-Analysis)
Meta-Analysis
Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies. Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL). Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review. The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in nonradiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable. Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate. No relationship was found between age, gender, and implant survival rates. Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients.
Topics: Dental Implants; Humans; Prospective Studies; Quality of Life; Retrospective Studies; Survival Rate
PubMed: 34281302
DOI: 10.23812/21-2supp1-5 -
Oral Oncology Jun 2022Topical fluoride is used for prevention of dental caries. However, its effectiveness and more specifically its formulation and frequency of application in patients... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Topical fluoride is used for prevention of dental caries. However, its effectiveness and more specifically its formulation and frequency of application in patients undergoing head and neck radiotherapy are still debatable. The aim of this systematic review was to pool the evidence of effectiveness of various topical fluorides in preventing radiation caries or change in bacterial growth in adult patients of head and neck cancer.
METHODS
Three databases (PubMed and Google Scholar and Cochrane) were searched for randomized controlled or uncontrolled trials or quasi randomised trials published till February 2021. Two independent reviewers screened 346 abstracts finally 14 articles were included in the current systematic review. Primary outcome evaluated was the prevention of radiation caries or change in bacterial growth in saliva. Meta-analysis was performed for the sub groups formed on the basis of fluoride formulations and adjuncts used with it.
RESULTS
Studies included were highly heterogeneous. Majority of studies found different fluoride formulations to be effective in controlling radiation caries to a variable extent up to 70% depending upon the intervention, patient compliance, rate of attrition and follow up period. Sodium fluoride was the most commonly used caries preventive agent. Meta-analysis showed no significant difference between sodium fluoride formulations and other fluoride agents. Fluoride treatment when incorporated with re-mineralising agent had no significant effect on caries prevention CONCLUSION: Fluoride prevents radiation caries. However, to delineate its exact formulation, dosage or frequency, there is need for more well conducted randomised controlled trials.
Topics: Adult; Cariostatic Agents; Dental Caries; Dental Caries Susceptibility; Fluorides; Fluorides, Topical; Humans; Sodium Fluoride
PubMed: 35483157
DOI: 10.1016/j.oraloncology.2022.105869 -
Ocular Oncology and Pathology Sep 2017To investigate whether lower radiation doses may yield similar outcome measures to those from the COMS trial. (Review)
Review
AIM
To investigate whether lower radiation doses may yield similar outcome measures to those from the COMS trial.
METHODS
A literature review of English language articles was performed using the PubMed database of the U.S. National Library of Medicine and the Cochrane Central Register of Controlled Trials using the following keywords: uveal melanoma, choroidal melanoma, primary uveal malignant melanoma, iodine-125 brachytherapy, local recurrence, local treatment failure, and local tumor control. The relationships between study local recurrence rate and median dosage were tested by linear regression, with each study weighted by the number of patients included.
RESULTS
Fifteen retrospective and prospective studies were selected for systematic review (2,662 patients). Ranges of reported mean or median radiation dose to tumor apex were 62.5-104.0 Gy. Local recurrence rates ranged from 0 to 24%. A 1.0-Gy increase in the average study dose was associated with a 0.14% decrease in local recurrence rate, which was not statistically significant ( value 0.336).
CONCLUSION
The gold standard empirically derived 85.0-Gy radiation dose for the treatment of uveal melanoma could be tested in a randomized study.
PubMed: 29071269
DOI: 10.1159/000455872 -
Thyroid : Official Journal of the... Dec 2021Patients with Graves' disease are commonly treated with radioiodine. There remains controversy over whether the aim of treatment should be to achieve euthyroidism or... (Meta-Analysis)
Meta-Analysis
A Systematic Review and Meta-Analysis of the Relationship Between the Radiation Absorbed Dose to the Thyroid and Response in Patients Treated with Radioiodine for Graves' Disease.
Patients with Graves' disease are commonly treated with radioiodine. There remains controversy over whether the aim of treatment should be to achieve euthyroidism or hypothyroidism, and whether treatments should be administered with standard levels of radioactivity or personalized according to the radiation absorbed doses delivered to the thyroid. The aim of this review was to investigate whether a relationship exists between radiation absorbed dose and treatment outcome. A systematic review and meta-analysis of all reports published before February 13, 2020, were performed using PubMed, Web of Science, OVID MEDLINE, and Embase. Proportion of patients achieving nonhyperthyroid status was the primary outcome. Secondary outcomes were proportion of patients who were specifically euthyroid or hypothyroid. A random-effects meta-analysis of proportions was performed for primary and secondary outcomes, and the impact of the radiation absorbed dose on treatment outcome was assessed through meta-regression. The study is registered with PROSPERO (CRD42020175010). A total of 1122 studies were identified of which 15, comprising 2303 Graves' disease patients, were eligible for the meta-analysis. A strong association was found between radiation absorbed dose and nonhyperthyroid and hypothyroid outcomes (odds ratio [OR] = 1.11 [95% confidence interval {CI} 1.08-1.14] and OR = 1.09 [CI 1.06-1.12] per 10 Gy increase). Higher rates of euthyroid outcome were found for radiation absorbed doses within the range 120-180 Gy when compared with outside this range ( = 1172, OR = 2.50 [CI 1.17-5.35], = 0.018). A maximum euthyroid response of 38% was identified at a radiation absorbed dose of 128 Gy. The presented radiation absorbed dose-response relationships can facilitate personalized treatment planning for radioiodine treatment of patients with Graves' disease. Further studies are required to determine how patient-specific covariates can inform personalized treatments.
Topics: Graves Disease; Humans; Iodine Radioisotopes; Radiotherapy Dosage; Thyroid Gland
PubMed: 34598656
DOI: 10.1089/thy.2021.0302 -
Actas Urologicas Espanolas 2015New therapeutic alternatives can improve the safety and efficacy of prostate cancer treatment. (Comparative Study)
Comparative Study Review
CONTEXT
New therapeutic alternatives can improve the safety and efficacy of prostate cancer treatment.
OBJECTIVES
To assess whether hypofractionated radiation therapy results in better safety and efficacy in the treatment of prostate cancer.
ACQUISITION OF EVIDENCE
Systematic review of the literature through searches on PubMed, Cochrane Library, CRD, ClinicalTrials and EuroScan, collecting indicators of safety and efficacy.
SYNTHESIS OF THE EVIDENCE
We included 2 systematic reviews and a clinical trial. In terms of efficacy, there is considerable heterogeneity among the studies, and no conclusive results were found concerning the superiority of the hypofractionated option over the normal fractionated option. In terms of safety, there were no significant differences in the onset of acute genitourinary complications between the 2 treatments. However, one of the reviews found more acute gastrointestinal complications in patients treated with hypofractionated radiation therapy. There were no significant differences in long-term complications based on the type of radiation therapy used, although the studies did have limitations.
CONCLUSIONS
To date, there are no conclusive results that show that hypofractionated radiation therapy is more effective or safer than normal fractionated radiation therapy in the treatment of localized prostate cancer.
Topics: Adenocarcinoma; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Gastrointestinal Diseases; Humans; Male; Male Urogenital Diseases; Meta-Analysis as Topic; Organs at Risk; Prostatic Neoplasms; Radiation Injuries; Radiotherapy; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 25660427
DOI: 10.1016/j.acuro.2014.12.005 -
Current Oncology Reports Jan 2017Radiation therapy is an integral component in the multimodality management of many gastrointestinal (GI) cancers at all stages of clinical presentation. With recent... (Review)
Review
Radiation therapy is an integral component in the multimodality management of many gastrointestinal (GI) cancers at all stages of clinical presentation. With recent advances in technology and radiation delivery, external beam radiation therapy (EBRT) can be delivered with reduced toxicity. However, despite these advances, EBRT doses are still limited by the presence of radiosensitive serial structures near clinical targets in the GI tract. Relative to EBRT techniques, brachytherapy techniques have a lower integral dose and more rapid fall-off, allowing for high-dose delivery with little normal tissue exposure. Given the unique characteristics of brachytherapy, it is an attractive strategy to treat GI malignancies. This review addresses the application of both high-dose rate brachytherapy (HDRBT) and low-dose rate brachytherapy (LDRBT) to multiple GI malignancies for both definitive and palliative management.
Topics: Brachytherapy; Combined Modality Therapy; Gastrointestinal Neoplasms; Gastrointestinal Tract; Humans; Radiation Injuries; Radiotherapy Dosage
PubMed: 28110462
DOI: 10.1007/s11912-017-0561-1 -
Head & Neck Jun 2019Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic review with meta-analysis demonstrates the effect that radiation has on swallowing.
METHODS
Selection and analysis of studies examining the effect of radiation to swallowing structures. A fixed effects meta-analysis calculated the pooled proportions for select outcomes of dysphagia, common across many studies.
RESULTS
The majority of the papers found a correlation between radiation dose to the swallowing structures and dysphagia, however a meta-analysis found the studies carried a significant degree of heterogeneity. The appraisal demonstrates the need for large-scale studies using a randomized design and instrumental dysphagia assessments.
CONCLUSIONS
Radiation dose to dysphagia and aspiration structures is correlated with incidence of dysphagia and aspiration. The variables in this population contribute to the heterogeneity within and cross studies and future studies should consider controlling for this.
Topics: Deglutition Disorders; Head and Neck Neoplasms; Humans; Pneumonia, Aspiration; Radiotherapy Dosage
PubMed: 30680831
DOI: 10.1002/hed.25631 -
Journal of Clinical Medicine Research Apr 2017Radiation necrosis (RN) of brain tissue is a serious late complication of brain irradiation and recently bevacizumab has been suggested as treatment option of RN. There... (Review)
Review
Radiation necrosis (RN) of brain tissue is a serious late complication of brain irradiation and recently bevacizumab has been suggested as treatment option of RN. There is a lack of data in the literature regarding the effectiveness of bevacizumab for the treatment of RN. The purpose of this review was to perform a comprehensive analysis of all reported cases using bevacizumab for the treatment of brain RN. In September 2016, we performed a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane Library. The research for the review was conducted using a combination of the keywords "radiation necrosis", "radiotherapy" and "bevacizumab" alongside the fields comprising article title, abstract and keywords. Randomized trials, non-randomized trials, prospective studies, retrospective studies and single case reports were included in the review. Our research generated 21 studies and 125 cases where bevacizumab had been used for the treatment of RN. The median follow-up was 8 months and the most frequent bevacizumab dose used was 7.5 mg/kg for 2 weeks with a median of four cycles. Low-dose bevacizumab resulted in effectiveness with improvement in both clinical and radiographic response. The median decrease in T1 contrast enhancement and in T2/FLAIR signal abnormality was 64% and 60%, respectively. A reduction in steroidal therapy was observed in majority of patients treated. Based on the data of our review, bevacizumab appears to be a promising agent for the treatment of brain RN. Future prospective studies are required to evaluate the role of bevacizumab in RN and to define the optimal scheduling, dosage and duration of therapy.
PubMed: 28270886
DOI: 10.14740/jocmr2936e -
Cancer Treatment Reviews Sep 2021Locoregional treatments (LRT) including radioembolisation (SIRT), transarterial chemo-embolisation (TACE), hepatic arterial infusion (HAI) of chemotherapy, external beam... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Locoregional treatments (LRT) including radioembolisation (SIRT), transarterial chemo-embolisation (TACE), hepatic arterial infusion (HAI) of chemotherapy, external beam radiotherapy (EBRT) and ablation have been studied for the management of intrahepatic cholangiocarcinoma (iCC). The aim of this systematic review was to provide outcome benchmarks for clinical trial design.
METHODS
Identification of studies reporting outcomes of patients treated with LRT for iCC was performed using PubMed and Embase. Pooled weighted means were calculated for progression-free survival (PFS) and overall survival (OS); meta-analysis of proportions was used for estimation of pooled response rate.
RESULTS
6325 entries were reviewed; 93 studies were eligible, representing 101 cohorts and 3990 patients: 15 cohorts (645 patients) for ablation, 18 cohorts (541 patients) for EBRT, 27 cohorts (1232 patients) for SIRT, 22 cohorts (1145 patients) for TACE, 16 cohorts (331 patients) for HAI and 3 cohorts (96 patients) not pooled. 74% of the studies were retrospective, 99% non-randomised. The pooled mean weighted OS was 30.2 months (95% confidence interval (CI): 21.8-38.6) for ablation, 18.9 (14.2-23.5) for EBRT, 14.1 (12.1-16.0) for SIRT, 15.9 (12.9-19.0) for TACE and 21.3 (15.4-27.1) for HAI. The pooled complete response rate was 93.9% for ablation. When analysed together, SIRT, TACE and HAI had a pooled mean weighted OS of 15.7 months, and 25.2 months for patients treated in first-line with concomitant systemic chemotherapy.
CONCLUSIONS
Available literature on LRT for iCC was heterogeneous and of insufficient quality to make strong recommendations. Ablation achieved satisfactory outcomes, and may be recommended when surgery is not feasible.
Topics: Ablation Techniques; Antineoplastic Agents; Bile Duct Neoplasms; Chemoembolization, Therapeutic; Cholangiocarcinoma; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Cohort Studies; Embolization, Therapeutic; Hepatic Artery; Humans; Infusions, Intra-Arterial; Randomized Controlled Trials as Topic; Yttrium Radioisotopes
PubMed: 34252720
DOI: 10.1016/j.ctrv.2021.102258 -
Practical Radiation Oncology 2023Inflammatory bowel disease (IBD) has historically been considered a relative contraindication for pelvic radiation therapy (RT). To date, no systematic review has... (Review)
Review
PURPOSE
Inflammatory bowel disease (IBD) has historically been considered a relative contraindication for pelvic radiation therapy (RT). To date, no systematic review has summarized the toxicity profile of RT for patients with prostate cancer and comorbid IBD.
METHODS AND MATERIALS
A PRISMA-guided systematic search was conducted on PubMed/Embase for original investigations that reported gastrointestinal (GI; rectal/bowel) toxicity in patients with IBD undergoing RT for prostate cancer. The substantial heterogeneity in patient population, follow-up, and toxicity reporting practices precluded a formal meta-analysis; however, a summary of the individual study-level data and crude pooled rates was described.
RESULTS
Twelve retrospective studies with 194 patients were included: 5 examined predominantly low-dose-rate brachytherapy (BT) monotherapy, 1 predominantly high-dose-rate BT monotherapy, 3 mixed external beam RT (3-dimensional conformal or intensity modulated RT [IMRT]) + low-dose-rate BT, 1 IMRT + high-dose-rate BT, and 2 stereotactic RT. Among these studies, patients with active IBD, patients receiving pelvic RT, and patients with prior abdominopelvic surgery were underrepresented. In all but 1 publication, the rate of late grade 3+ GI toxicities was <5%. The crude pooled rate of acute and late grade 2+ GI events was 15.3% (n = 27/177 evaluable patients; range, 0%-100%) and 11.3% (n = 20/177 evaluable patients; range, 0%-38.5%), respectively. Crude rates of acute and late grade 3+ GI events were 3.4% (6 cases; range, 0%-23%) and 2.3% (4 cases; range, 0%-15%).
CONCLUSIONS
Prostate RT in patients with comorbid IBD appears to be associated with low rates of grade 3+ GI toxicity; however, patients must be counseled regarding the possibility for lower-grade toxicities. These data cannot be generalized to the underrepresented subpopulations mentioned above, and individualize decision-making is recommended for those high-risk cases. Several strategies should be considered to minimize the probability of toxicity in this susceptible population, including careful patient selection, minimizing elective (nodal) treatment volumes, using rectal sparing techniques, and employing contemporary RT advancements to minimize exposure to GI organs at risk (eg, IMRT, magnetic resonance imaging-based target delineation, and high-quality daily image guidance).
Topics: Humans; Male; Inflammatory Bowel Diseases; Prostatic Neoplasms; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Retrospective Studies
PubMed: 37100389
DOI: 10.1016/j.prro.2023.04.006