Systematic reviewThe effect of radiotherapy, and radiotherapy combined with bisphosphonates or RANK ligand inhibitors on bone quality in bone metastases. A systematic review
Section snippets
Search strategy
PubMed, EMBASE and the Cochrane Library were searched (last search performed November 26th, 2015). No limits were used for PubMed and the Cochrane Library. The search in EMBASE was limited to articles, errata, and reviews. The search strategy included search terms and their synonyms for bone metastases, radiotherapy, bisphosphonates, RANKL inhibitors, bone mineral density, bone quality and bone strength. The search strategy was developed in collaboration with information specialists from the
Study selection
The search strategy retrieved 3273 unique records. Subsequent selection procedure resulted in 37 eligible articles. Two additional relevant articles were found via cross-referencing. Thus, 39 studies [17], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66] were included in this systematic review (Fig. 1). Vassiliou et al.
Discussion
We conducted this study to systematically review all studies on the effect of (1) radiotherapy, (2) radiotherapy combined with bisphosphonates, and (3) radiotherapy combined with RANKL inhibitors on bone quality and bone strength parameters in bone metastases originating from solid tumors.
In clinical practice, patients are often treated with a combination of local radiotherapy and systemic treatments. These systemic treatments include e.g. anticancer treatments with chemotherapy or hormonal
Conclusion
Based on this systematic review, it can be concluded there was no sufficient evidence that radiotherapy had a positive effect on bone quality and fracture risk. In addition, animal studies showed that the addition of BPs to radiotherapy restored bone quality and bone strength to that of healthy bone, whereas this is not yet proven in patients. Furthermore, there were neither animal nor patient studies addressing the effect of RANKL inhibitors as an adjunct to radiotherapy on bone quality and
Author contributions
All authors have made substantial contributions to all three of the following sections:
- 1)
The conception and design of the study, or acquisition of data, or analysis and interpretation of data;
- 2)
Drafting the article or revising it critically for important intellectual content; and
- 3)
Final approval of the version to be submitted.
Conflicts of interest statement
No conflict of interest
Acknowledgments
We greatly appreciate the help of Elmie Peters and Alice Tillema from the Radboud University Nijmegen Library of Medical Sciences with developing the search strategy. This study was funded internally by the Radboudumc.
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