类风湿性关节炎与放疗毒性风险之间的关系:系统综述

Nina Liebenberg, Alan McWilliam, Sarah L Kerns, Deborah C Marshall, C. West
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引用次数: 0

摘要

有时,人们对类风湿性关节炎(RA)患者使用放疗治疗癌症表示担忧,但几乎没有证据支持避免使用放疗。确定类风湿性关节炎与放疗毒性风险之间的任何关联都会影响目前的指导意见。我们的目标是回顾证据基础。根据《2020 年系统综述和元分析首选报告项目》指南,我们于 2019 年 11 月 25 日对 Medline、Embase 和 PubMed 数据库进行了系统综述,并于 2024 年 2 月 22 日进行了更新。两名独立评审员对确定纳入的文章进行了审查。共确定了 155 篇文章。在排除重复文章后,剩下 114 篇文章。12 篇文章被纳入定性分析。六项研究未进行比较队列;一项研究将RA患者与无RA胶原血管病(CVD)的患者进行了比较;五项研究将RA患者与CVD患者或配对患者进行了比较。研究显示,RA 患者的毒性水平较高;但只有两项研究的结果具有统计学意义。12 项研究中有 9 项研究的证据质量为中低水平,并显示出多种偏倚倾向。由于高质量的研究有限,很难就 RA 与放疗毒性之间的关系得出明确的结论。鉴于本综述目前缺乏强有力的高质量证据,因此缺乏足够的证据来建议减少RA患者的放疗剂量。需要进一步开展高质量的研究,包括毒性的前瞻性分析、最新的放疗技术、长期随访和大型队列。此外,分析还需要调整混杂因素、匹配风险因素并纳入RA活动状态评估。
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Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review
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. 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. 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. 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.
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