A (relatively) risky business: the link between prostatic radiotherapy and second malignancies
A partir d'une revue systématique de la littérature publiée jusqu'en 2015 (21 études), cette méta-analyse évalue l'association entre la radiothérapie et le risque de second cancer primitif chez des patients atteints d'un cancer de la prostate
Unlikely to change therapeutic decisions for most men with high grade prostate cancerThere is a well recognized association between exposure to radiation and carcinogenesis.1 The development of second malignancies after therapeutic radiation depends on the primary malignancy, the dose to tissues at risk, and specific characteristics of the patient.2 There is a strong association between radiotherapy and second malignancies in people with Hodgkin’s lymphoma3 4 and patients with other cancers treated with radiotherapy.5 6 Data linking radiotherapy for prostate cancer and subsequent malignancy have been less clear. Defining such a link has been difficult because the population is older and has a limited natural lifespan with prominent competing health risks. In addition, the relatively small number of outcomes in these analyses limits their statistical validity. Previous systematic reviews and one small meta-analysis reported inconsistent conclusions.7 8 9In a linked paper, Wallis and colleagues (doi:10.1136/bmj.i851)10 refresh the existing data with an updated comprehensive systematic review and meta-analysis of 21 studies evaluating the association between prostatic irradiation …