Prophylactic irradiation of tracts in patients with malignant pleural mesothelioma: A systematic review and meta-analysis of randomized trials

[Display omitted] The role of prophylactic irradiation of tracts (PIT) to prevent tumor seeding at the site of a diagnostic or therapeutic intervention in patients with malignant pleural mesothelioma (MPM) is controversial. This study aimed to determine the efficacy of PITs in preventing procedure t...

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Bibliographic Details
Published in:Critical reviews in oncology/hematology 2021-04, Vol.160, p.103278-103278, Article 103278
Main Authors: Lee, Chia Ching, Soon, Yu Yang, Vellayappan, Balamurugan, Leong, Cheng Nang, Koh, Wee Yao, Tey, Jeremy C.S.
Format: Article
Language:English
Subjects:
Humans
Malignant pleural mesothelioma
Mesothelioma - radiotherapy
Mesothelioma, Malignant
Meta-analysis
Neoplasm Seeding
Pleural Neoplasms - radiotherapy
Procedural tract metastases
Prophylactic irradiation of tracts
Radiation therapy
Randomized Controlled Trials as Topic
Systematic review
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Summary:[Display omitted] The role of prophylactic irradiation of tracts (PIT) to prevent tumor seeding at the site of a diagnostic or therapeutic intervention in patients with malignant pleural mesothelioma (MPM) is controversial. This study aimed to determine the efficacy of PITs in preventing procedure tract metastases (PTM) after a chest wall procedure in MPM. We searched various databases from inception date to April 2020 for randomized controlled trials (RCTs) comparing PIT with no PIT in patients who had a chest wall procedure for MPM. We assessed the risk of bias of individual RCT using the RoB2 tool. The primary outcome was the occurrence of PTM. Meta-analysis was performed using random-effects model. We employed the GRADE approach to assess the certainty of the evidence. We identified five RCTs including 737 patients. Two RCTs had a low risk of bias. PIT was associated with a significant reduction in the odds of PTM (odd ratio, 0.55; 95 % confidence interval, 0.32 to 0.95; P-value = 0.03; I2 = 13 %; GRADE: moderate certainty). One RCT reported no difference in overall survival outcome with the use of PIT. None of the RCTs performed subgroup analyses. Sensitivity analyses showed similar results when limited to RCTs with low risk of bias. PIT significantly reduces the occurrence of PTM in patients with MPM who had a diagnostic or therapeutic chest wall procedure.
ISSN:1040-8428
1879-0461
DOI:10.1016/j.critrevonc.2021.103278