Radiation toxicity in patients with collagen vascular disease: A meta-analysis of case-control studies. Journal Article

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Authors: Shaikh, PM; Singh, SA; Alite, F; Vargo, JA; Emami, B; Wu, MJ; Jacobson, G; Bakalov, V; Small, W; Dahshan, B; Weir, J; Renz, PB; Harkenrider, MM
Article Title: Radiation toxicity in patients with collagen vascular disease: A meta-analysis of case-control studies.
Abstract: BACKGROUND: Several retrospective series have reported that patients with collagen vascular disease (CVD) are at increased risk of radiation (RT) toxicity. However, the evidence is mixed, and many series lack control groups. We performed a meta-analysis including only case-cohort or randomized studies examining the risk of RT toxicity for patients with CVD compared to controls. METHODS: MOOSE guidelines were used to perform a comprehensive search identifying case-control or randomized studies reporting RT toxicity outcomes for patients with CVD versus controls. Data were synthesized from studies reporting grade 2 to 3 or more (G2/3+) acute and late RT toxicities. Results were analyzed on the random-effects (RE) model for between-study heterogeneity, otherwise the fixed-effects model (FE) was used. Hazard ratio (HR) or odds ratio (OR) were the effect-size estimators, as appropriate. RESULTS: Ten studies were included with 4,028 patients (CVD: 406, control: 3622). Patients with CVD had higher rates of acute G2/3+ toxicity (26.2% vs. 16.5%, OR 2.01, p0.001) and late G2/3+ toxicity (18.4% vs 10.1%, OR 2.37, p0.001). Higher rates of late G2/3+ toxicity were observed for CVD patients with systemic lupus erythematous (21% vs. 9.7%, OR 2.55, p=0.03), systemic scleroderma (31.8% vs. 9.7%, OR 3.85, p=0.03), rheumatoid arthritis (11.7% vs. 8.4%, OR=2.56; p=0.008), and those irradiated to the pelvis/abdomen (32.2% vs 11.9%, OR 3.29, p=0.001), breast (14.7% vs 4.4%, OR 3.51, p=0.003), thorax (12.5% vs 8.7%, OR 3.46, p0.001), and skin (14.6% vs 5.2%, OR 2.59, p=0.02). Late grade 5 toxicities were significantly higher for patients with CVD, although absolute rates were low (3.9% vs 0.6%, OR=7.81, p=0.01). CONCLUSIONS: Moderate and severe toxicities are more likely in patients with CVD, with variable risk depending on toxicity grade, CVD subtype, treatment site, and dose. Severe toxicities are uncommon. These factors should be considered when informing patients of treatment-related risks and monitoring for morbid treatment sequelae.
Journal Title: International journal of radiation oncology, biology, physics
ISSN: 1879-355X; 0360-3016
Publisher: Elsevier Inc  
Date Published: 2021