Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review
Objective There is sometimes concern over the use of radiotherapy for cancer in individuals with rheumatoid arthritis (RA), but there is little evidence to support its avoidance. Identifying any association between RA and risk of radiotherapy toxicity could impact current guidance. We aimed to revie...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-09-01
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| Series: | BMJ Oncology |
| Online Access: | https://bmjoncology.bmj.com/content/3/1/e000407.full |
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| author | Nina Liebenberg Alan McWilliam Sarah L Kerns Deborah C Marshall Catharine M West |
| author_facet | Nina Liebenberg Alan McWilliam Sarah L Kerns Deborah C Marshall Catharine M West |
| author_sort | Nina Liebenberg |
| collection | DOAJ |
| description | Objective There is sometimes concern over the use of radiotherapy for cancer in individuals with rheumatoid arthritis (RA), but there is little evidence to support its avoidance. Identifying any association between RA and risk of radiotherapy toxicity could impact current guidance. We aimed to review the evidence base.Design Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a systematic review was conducted of Medline, Embase and PubMed databases on 25 November 2019 and updated 22 February 2024. Articles identified for inclusion were reviewed by two independent assessors.Results 155 articles were identified. With repeat articles excluded, 114 remained. 12 articles were included in qualitative analysis. Six studies held no comparison cohort; one compared patients with RA to patients without RA collagen vascular disease (CVD); five compared patients with RA to CVD or a matched pair. Studies showed patients with RA developed higher levels of toxicity; however, only two studies had statistically significant results. Nine of the 12 studies had medium-to-low quality evidence and displayed predisposition to numerous biases. Due to limited high-quality research, it is difficult to draw a clear conclusion on the relationship between RA and radiotherapy toxicity.Conclusion Given the current lack of strong and high-quality evidence identified in this review, dose reduction of radiotherapy in patients with RA lacks sufficient evidence to be recommended. There is a need for further high-quality research involving prospective analyses of toxicity, up-to-date radiotherapy techniques, long follow-up and large cohorts. Also, analyses need to adjust for confounding factors, match for risk factors and incorporate RA activity status assessments. |
| format | Article |
| id | doaj-art-38f2b402d1f24ff6b9b3c50116be35f9 |
| institution | OA Journals |
| issn | 2752-7948 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Oncology |
| spelling | doaj-art-38f2b402d1f24ff6b9b3c50116be35f92025-08-20T02:11:22ZengBMJ Publishing GroupBMJ Oncology2752-79482024-09-013110.1136/bmjonc-2024-000407Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic reviewNina Liebenberg0Alan McWilliam1Sarah L Kerns2Deborah C Marshall3Catharine M West4Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UKDivision of Cancer Science, The University of Manchester, Manchester, UKDepartment of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USADepartment of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USADivision of Cancer Science, The University of Manchester, Manchester, UKObjective There is sometimes concern over the use of radiotherapy for cancer in individuals with rheumatoid arthritis (RA), but there is little evidence to support its avoidance. Identifying any association between RA and risk of radiotherapy toxicity could impact current guidance. We aimed to review the evidence base.Design Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a systematic review was conducted of Medline, Embase and PubMed databases on 25 November 2019 and updated 22 February 2024. Articles identified for inclusion were reviewed by two independent assessors.Results 155 articles were identified. With repeat articles excluded, 114 remained. 12 articles were included in qualitative analysis. Six studies held no comparison cohort; one compared patients with RA to patients without RA collagen vascular disease (CVD); five compared patients with RA to CVD or a matched pair. Studies showed patients with RA developed higher levels of toxicity; however, only two studies had statistically significant results. Nine of the 12 studies had medium-to-low quality evidence and displayed predisposition to numerous biases. Due to limited high-quality research, it is difficult to draw a clear conclusion on the relationship between RA and radiotherapy toxicity.Conclusion Given the current lack of strong and high-quality evidence identified in this review, dose reduction of radiotherapy in patients with RA lacks sufficient evidence to be recommended. There is a need for further high-quality research involving prospective analyses of toxicity, up-to-date radiotherapy techniques, long follow-up and large cohorts. Also, analyses need to adjust for confounding factors, match for risk factors and incorporate RA activity status assessments.https://bmjoncology.bmj.com/content/3/1/e000407.full |
| spellingShingle | Nina Liebenberg Alan McWilliam Sarah L Kerns Deborah C Marshall Catharine M West Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review BMJ Oncology |
| title | Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review |
| title_full | Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review |
| title_fullStr | Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review |
| title_full_unstemmed | Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review |
| title_short | Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review |
| title_sort | association between rheumatoid arthritis and risk of radiotherapy toxicity a systematic review |
| url | https://bmjoncology.bmj.com/content/3/1/e000407.full |
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