P042 Inflammatory bowel disease is no longer a contraindication for radiation therapy: A systematic review of outcomes with modern RT techniques
Bibliographic record
Abstract
BACKGROUND: Inflammatory bowel disease (IBD) continues to be considered a contraindication to the use of Radiation Therapy (RT). Oncologists are often unwilling to deliver RT, due to a perceived risk of severe bowel toxicity, or IBD exacerbation. Modern precision RT techniques allow significant reduction in dose to normal organs, and several studies have reported low toxicity rates. We performed a systematic review of recent studies to summarize the current evidence regarding RT toxicity in cancer patients with IBD. METHODS: MEDLINE and EMBASE databases were searched, using combinations of key terms, for relevant studies published over the past 10 years (2008–2018). Reference lists of eligible articles were also hand-searched. A total of 278 articles were screened, and 9 studies met our search criteria to be included in this review. RESULTS: From the 9 relevant studies, 198 patients with IBD, treated using radiation therapy, and with outcome data available, were included. The reported median follow-up was 55.2 months. The majority of patients (n = 148, 75%) were male; 113 (57%) had Ulcerative Colitis, 81 (41%) had Crohn's Disease, and 4 patients had IBD NOS. Nineteen patients (9.5%) were reported to have active IBD within 6 -12 months prior to starting RT. Colo-rectal carcinoma was the most common malignancy (n = 91, 46%), followed by prostate cancer (n = 83, 42%), anal-canal (n = 10, 5%), and gynecological malignancies (n = 6, 3%). External beam RT was used as part of treatment for 173 patients (87%), while 25 received brachytherapy alone. About 28% (n = 55) also received concurrent chemotherapy. From studies that reported the RT technique used, about 43% of patients were treated with Intensity Modulated RT (IMRT). RT dose ranged from 25 Gy/5 for pre-op rectal cancers to over 70 Gy for prostate cancers. Median BED (a/b = 3, rectum) was calculated to be 83.3 Gy. Acute toxicity data was available for 190 patients: clinically significant acute toxicity, ≥Grade 3, was reported in 29 patients (15.3%). Late RT toxicity data was available for 115 patients: ≥Grade 2 GI toxicity was reported in 21 (10.5%), and ≥Grade 3 in 7 (3.5%) of patients. CONCLUSION(S): With the use of modern RT techniques, GI toxicity is relatively low for patients with IBD, and is not numerically different from that reported for patients without IBD. Patient selection and meticulous RT planning is important, however, evidence does not suggest that IBD in itself is a contraindication for RT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.009 |
| Bibliometrics | 0.010 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".