Salvage radiotherapy for postoperative locoregional failure in esophageal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
N Mummudi ◽  
S Jiwnani ◽  
D Niyogi ◽  
S Srinivasan ◽  
S Ghosh-Laskar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Survival Curve ◽  
Meta Analysis ◽  
Concurrent Chemotherapy ◽  
Salvage Radiotherapy ◽  
Anastomotic Site ◽  
Concomitant Chemotherapy ◽  
Salvage Radiation Therapy ◽  
Grade 3

Summary Locoregional recurrences following surgery for esophageal cancers represent a significant clinical problem with no standard recommendations for management. We conducted this systematic review and meta-analysis with the objective of studying safety and efficacy of salvage radiotherapy in this setting. All prospective and retrospective cohort studies, which studied patients who developed locoregional recurrence following initial radical surgery for esophageal cancer and subsequently received salvage radiation therapy (RT)/chemoradiation with all relevant information regarding survival outcome and toxicity available, were included. The quality of eligible individual studies was assessed using the Newcastle-Ottawa Scale score for risk of bias. R package MetaSurv was used to obtain a summary survival curve from survival probabilities and numbers of at-risk patients collected at various time points and to test the overall heterogeneity using the I2 statistic. Thirty studies (27 retrospective, 3 prospective) published from 1995 to 2020 with 1553 patients were included. The median interval between surgery and disease recurrence was 12.5 months. The median radiation dose used was 60 Gy and 57% received concurrent chemotherapy. The overall incidence of acute grade 3/4 mucositis and dermatitis were 8 and 4%, respectively; grade 3/4 acute pneumonitis was reported in 5%. The overall median follow-up of all studies included was 27 months. The 1-, 2- and 3-year overall survival (OS) probabilities were 67.9, 35.9 and 30.6%, respectively. Factors which predicted better survival on multivariate analysis were good PS, lower group stage, node negativity at index surgery, longer disease-free interval, nodal recurrence (as compared to anastomotic site recurrence), smaller disease volume, single site of recurrence, RT dose >50 Gy, conformal RT, use of concomitant chemotherapy and good radiological response after radiotherapy. Salvage radiotherapy with or without concomitant chemotherapy for locoregional recurrences after surgery for esophageal cancer is safe and effective. Modern radiotherapy techniques may improve outcomes and reduce treatment-related morbidity.

scholarly journals Risk of hypertension with bevacizumab, an antibody against vascular endothelial growth factor A: a systematic review and meta-analysis

2019 ◽  
Vol 8 (10) ◽  
pp. 2354
Author(s):  
Mandar K. Shah ◽  
Mihika A. Shah ◽  
Sharan D. Shah
Keyword(s):  
Systematic Review ◽  
Low Dose ◽  
Meta Analysis ◽  
Concurrent Chemotherapy ◽  
High Dose ◽  
Vascular Endothelial ◽  
Exclusion Criteria ◽  
Increased Risk ◽  
Grade 3 ◽  
Endothelial Growth Factor

Bevacizumab, a humanized antibody against VEGF, is effective in the treatment of patients with many cancers. However, as with many therapeutic agents, significant side effects are associated with bevacizumab, Hypertension is one of the predominant toxicity. We performed a systematic review and meta-analysis of published clinical trials of bevacizumab to quantify the risk of hypertension. 15 studies following PRISMA guidelines and matching inclusion and exclusion criteria were collected in which a group of patients were either treated with Bevacizumab and a concurrent chemotherapy and another group treated with Placebo and the same chemotherapy. Relative risk (RR) was calculated. P<0.05 was considered statistically significant. RevMan 5.3 software was used for the analysis. A total of 13,070 patients were included. Bevacizumab was associated with a significant increased risk of overall hypertension (RR=3.509; 95% C.I:2.451 to 5.023). 11 trials are included for determining the risk of Grade 3 hypertension including 8799 patients with a significant increased risk (RR=3.909; 95%C.I:1.983 to 7.707). 7 trials are included for determining the risk of hypertension at low dose (2.5 mg/kg/cycle) including 3691 patients associated with a significant increased (RR=2.640; 95%C.I: 1.408 to 4.950). 10 trials are included for determining the risk of hypertension at high dose (5 mg/kg/cycle) including 9379 patients associated with a significant (RR=4.036; 95%C.I: 2.948 to 5.525). Our meta-analysis has demonstrated that bevacizumab may be associated with a significantly increased risk of hypertension in patient with a variety of metastatic solid tumors irrespective of dosing.

scholarly journals Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review

2020 ◽  
Vol 11 (15) ◽  
pp. 4605-4613 ◽  
Author(s):  
Linlin Xiao ◽  
Brian G. Czito ◽  
Qingsong Pang ◽  
Zhouguang Hui ◽  
Shaowu Jing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Meta Analysis ◽  
Concurrent Chemotherapy ◽  
Definitive Treatment ◽  
Radiation Doses

scholarly journals Factors affecting the incidence of postoperative periprosthetic fractures following primary and revision hip arthroplasty: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Christos Bissias ◽  
Angelos Kaspiris ◽  
Athanasios Kalogeropoulos ◽  
Konstantinos Papoutsis ◽  
Nikolaos Natsioulas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Revision Arthroplasty ◽  
Female Gender ◽  
Periprosthetic Fractures ◽  
Factors Affecting ◽  
Potential Risk Factors ◽  
Grade 3

Abstract Objectives The increasing number of hip arthroplasties (HA), due to the growing elderly population, is associated with the risk of femoral periprosthetic fractures (FPFs). The purpose of this study was to identify potential risk factors for the development of FPFs after HA. Methods A systematic review was conducted in five data bases (Medline, Embase, Cochrane, Cinahl, ICTRP) according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines up to May 2019, using the key words “risk factor,” “periprosthetic fracture,” and “hip replacement or arthroplasty.” Meta-analysis of the clinical outcomes of HA and subgroup analysis based on the factors that were implicated in FPFs was performed. Results Sixteen studies were included (sample size: 599,551 HA patients, 4253 FPFs, incidence 0.71%). Risk factors statistically associated with increased incidence of FPFs were female gender (+ 40%), previous revision arthroplasty surgery (× 3 times), and the presence of rheumatoid arthritis (× 2.1 times), while osteoarthritis (− 57%), cement application (− 59%), and insertion of Biomet (− 68%) or Thompson’s prosthesis (− 75%) were correlated with low prevalence of FPFs. Obesity, cardiac diseases, advanced age, bad general health (ASA grade ≥ 3), and use of Exeter or Lubinus prosthesis were not linked to the appearance of FPFs. Conclusion This meta-analysis suggested that female gender, rheumatoid arthritis, and revision arthroplasty are major risk factors for the development of FPFs after a HA. In those patients, frequent follow-ups should be planned. Further prospective studies are necessary to clarify all the risk factors contributing to the appearance of FPFs after HA.

scholarly journals Effect of Salvage Radiotherapy and Endocrine Therapy on Patients with Biochemical Recurrence After Prostate Cancer Operation— a Meta‑Analysis

2021 ◽  
Vol 15 (3) ◽  
pp. 155798832110248
Author(s):  
Yong Yuan ◽  
Qiang Zhang ◽  
Chaofan Xie ◽  
Tao Wu
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Endocrine Therapy ◽  
Androgen Deprivation Therapy ◽  
Biochemical Recurrence ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Androgen Deprivation ◽  
Salvage Radiotherapy ◽  
End Point

Context: Several studies reported the application of androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. Objective: To perform a systematic review and meta-analysis evaluating of endocrine therapy and radiotherapy in patients with biochemical recurrence after prostate cancer surgery. The primary end point was biochemical progression-free survival (bPFS). Secondary end point was overall survival (OS). Methods: A systematic review of PubMed/Medline, Embase, and Cochrane databases to identify relevant studies published in English up to March 2020. Twelve studies were selected for inclusion. Results: There were 11 studies included in the present study. Including two randomized controlled trials and nine cohort studies. The meta-analysis shows a significant bPFS benefit from androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. (hazard ratio [HR]: 0.57; 95% confidence interval CI, 0.52–0.63; p < .001). For patients with GS < 7 and low-risk patients, combined treatment can have a benefit for BPFs (HR: 0.53; 95% CI, 0.37–0.76; HR: 0.58; 95% CI, 0.36–0.93). Androgen deprivation therapy and radiotherapy in patients with biochemical recurrence was associated with a slightly OS improvement (HR: 0.73; 95% CI, 0.57–0.93; p = 0.01). Conclusions: Compared with salvage radiotherapy alone, This meta-analysis shows a significant bPFS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence after prostate cancer operation. And benefit more for high-risk groups. However, there was no significant benefit in group GS ≥ 8. It shows a slightly OS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence.

scholarly journals A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Or ◽  
B. Liu ◽  
J. Lam ◽  
S. Vinod ◽  
W. Xuan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Decision Making ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cardiac Events ◽  
Grade 3

AbstractTreatment-related toxicity is an important component in non-small cell lung cancer (NSCLC) management decision-making. Our aim was to evaluate and compare the toxicity rates of curative and palliative radiotherapy with and without chemotherapy. This meta-analysis provides better quantitative estimates of the toxicities compared to individual trials. A systematic review of randomised trials with > 50 unresectable NSCLC patients, treated with curative or palliative conventional radiotherapy (RT) with or without chemotherapy. Data was extracted for oesophagitis, pneumonitis, cardiac events, pulmonary fibrosis, myelopathy and neutropenia by any grade, grade ≥ 3 and treatment-related deaths. Mantel–Haenszel fixed-effect method was used to obtain pooled risk ratio. Forty-nine trials with 8609 evaluable patients were included. There was significantly less grade ≥ 3 acute oesophagitis (6.4 vs 22.2%, p < 0.0001) and any grade oesophagitis (70.4 vs 79.0%, p = 0.04) for sequential CRT compared to concurrent CRT, with no difference in pneumonitis (grade ≥ 3 or any grade), neutropenia (grade ≥ 3), cardiac events (grade ≥ 3) or treatment-related deaths. Although the rate of toxicity increased with intensification of treatment with RT, the only significant difference between treatment regimens was the rate of oesophagitis between the use of concurrent and sequential CRT. This can aid clinicians in radiotherapy decision making for NSCLC.

Brachytherapy for the palliation of dysphagia owing to esophageal cancer: A systematic review and meta-analysis of prospective studies

2017 ◽  
Vol 122 (3) ◽  
pp. 332-339 ◽  
Author(s):  
Lorenzo Fuccio ◽  
Daniele Mandolesi ◽  
Andrea Farioli ◽  
Cesare Hassan ◽  
Leonardo Frazzoni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Prospective Studies ◽  
Meta Analysis
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