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Risk of secondary rectal cancer and colon cancer after radiotherapy for prostate cancer: a meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether radiotherapy for prostate cancer increases the risk of therapy-related rectal cancer and colon cancer.

Methods

A systematic literature search was carried out using the Medline (PubMed), EMBASE, and the Cochrane Library to identify studies examining the association between radiotherapy for prostate cancer and secondary colorectal cancer (rectal cancer and colon cancer) published before March 19, 2018. The risk of second colorectal cancer after radiotherapy was summarized using unadjusted odds ratio (OR) and adjusted hazard ratio (HR) with their 95% confidence interval (CI). Subgroup and sensitivity analyses were conducted to detect potential bias and heterogeneity.

Results

After study selection, 16 reports were retrieved for analysis. When patients received radiotherapy compared with those unexposed to radiation, there was an increased risk of the rectal cancer (OR 1.37, 95%CI 1.01 to 1.85), but not colon cancer. According to adjusted HR, there was an increased risk of the rectal cancer (HR 1.64, 95%CI 1.39 to 1.94), and colon cancer (HR 1.33, 95%CI 1.02 to 1.76). The OR for rectal cancer showed an increased risk with longer latent period (5 years lag time versus 10 years lag time, OR: 1.56 versus 2.22). Brachytherapy had no association with second cancer across all analyses.

Conclusions

Radiotherapy was associated with an increased risk of subsequent rectal cancer compared with patients unexposed to radiation. Colon may be free from the damage of radiation. Brachytherapy had no association with second rectal cancer or colon cancer.

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Funding

This work was supported by the grants from National Natural Science Foundation of China (No. 81372774, No. 81572537 for Zhigang Zhao), The Key Program of Natural Science Foundation of Guangdong Province (No. 2015A030311007 for Zhigang Zhao), Yangcheng Scholar Project of Guangzhou Education Bureau (No. 12A014G for Zhigang Zhao), Science and Technology Program of Guangzhou (No. 201607010376 for Zhigang Zhao), and Science and Technology Planning Project of Guangdong Province (No.2017B030314108).

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Author notes

  1. Zhiguo Zhu and Shankun Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, Guangdong, China

    Zhiguo Zhu, Shankun Zhao, Yangzhou Liu, Jiamin Wang, Lianmin Luo, Ermao Li, Chaofeng Zhang, **tai Luo & Zhigang Zhao

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  1. Zhiguo Zhu
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Supplementary fig. 1

Begg’s and Egger’s tests to detect publication bias Footnotes: Rectal cancer: RT versus no-RT, 10 studies, Begg’s P > |z| = 0.152, Egger’s P > |t| = 0.634, 95%CI -3.34-2.16; RT: radiotherapy (PNG 84 kb)

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Supplementary table 1

Newcastle-Ottawa Scale assessment of the quality of the cohort studies (DOC 45 kb)

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Search strategy (DOC 36 kb)

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Zhu, Z., Zhao, S., Liu, Y. et al. Risk of secondary rectal cancer and colon cancer after radiotherapy for prostate cancer: a meta-analysis. Int J Colorectal Dis 33, 1149–1158 (2018). https://doi.org/10.1007/s00384-018-3114-7

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