Abstract
Objective
To systematically aggregate and summarize existing data on fistula prevalence among
patients with a history of pelvic radiotherapy for prostate cancer.
Materials and Methods
We queried PubMed, Embase, and Web of Science on October 7, 2020 for peer-reviewed
publications pertaining to radiation-induced fistulas in the pelvis. For meta-analysis,
we used the random-effects model. We used the I2 statistic to quantify heterogeneity and the Newcastle-Ottawa Scale to assess risk
of bias.
Results
Our final meta-analysis included 6 cohort studies with a total of 7665 patients exposed
to pelvic radiotherapy between 1967 and 2013. Median follow-up time was 35.5 months
(IQR 33.5-57.5). Pooled prevalence of radiation-induced fistula across all 6 cohort
studies was 0.2% (95% CI: 0.1-0.4, I2 = 0.000%, P < .608). In subgroup analysis, we did not detect significant heterogeneity in fistula
prevalence in patients who were re-irradiated (0.3%, 95% CI: 0.1-0.4; P = .762) or patients on concurrent chemotherapy (0.4%, 95% CI: -0.3 -1.2; P = .664) compared to those receiving their first course of radiotherapy alone. No
randomized controlled trials met inclusion criteria due to ambiguous and inconsistent
reporting language for fistula occurrence.
Conclusion
There is limited published literature reporting fistula as an adverse event of prostate
cancer radiotherapy, especially in the medium and long-term period. Patients undergoing
pelvic radiotherapy for prostate cancer appear at low short-term risk for developing
fistulas. Adverse event reporting in randomized controlled trials merits greater granularity
where fistulas should be reported with specificity rather than aggregating into broad
categories of genitourinary or gastrointestinal adverse events.
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Article info
Publication history
Published online: March 22, 2023
Accepted:
March 12,
2023
Received:
December 23,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: All Authors: The authors have no conflicts of interest to disclose. The project did not have a sponsor. The manuscript's first draft was written by Michael Sadighian without an honorarium, grant, or any other form of payment.
Identification
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