Abstract:
OBJECTIVE:To determine the association between exposure to radiotherapy for the treatment of prostate cancer and subsequent second malignancies (second primary cancers). DESIGN:Systematic review and meta-analysis of observational studies. DATA SOURCES:Medline and Embase up to 6 April 2015 with no restrictions on year or language. STUDY SELECTION:Comparative studies assessing the risk of second malignancies in patients exposed or unexposed to radiotherapy in the course of treatment for prostate cancer were selected by two reviewers independently with any disagreement resolved by consensus. DATA EXTRACTION AND SYNTHESIS:Two reviewers independently extracted study characteristics and outcomes. Risk of bias was assessed with the Newcastle-Ottawa scale. Outcomes were synthesized with random effects models and Mantel-Haenszel weighting. Unadjusted odds ratios and multivariable adjusted hazard ratios, when available, were pooled. MAIN OUTCOME MEASURES:Second cancers of the bladder, colorectal tract, rectum, lung, and hematologic system. RESULTS:Of 3056 references retrieved, 21 studies were selected for analysis. Most included studies were large multi-institutional reports but had moderate risk of bias. The most common type of radiotherapy was external beam; 13 studies used patients treated with surgery as controls and eight used patients who did not undergo radiotherapy as controls. The length of follow-up among studies varied. There was increased risk of cancers of the bladder (four studies; adjusted hazard ratio 1.67, 95% confidence interval 1.55 to 1.80), colorectum (three studies; 1.79, 1.34 to 2.38), and rectum (three studies; 1.79, 1.34 to 2.38), but not cancers of the hematologic system (one study; 1.64, 0.90 to 2.99) or lung (two studies; 1.45, 0.70 to 3.01), after radiotherapy compared with the risk in those unexposed to radiotherapy. The odds of a second cancer varied depending on type of radiotherapy: treatment with external beam radiotherapy was consistently associated with increased odds while brachytherapy was not. Among the patients who underwent radiotherapy, from individual studies, the highest absolute rates reported for bladder, colorectal, and rectal cancers were 3.8%, 4.2%, and 1.2%, respectively, while the lowest reported rates were 0.1%, 0.3%, and 0.3%. CONCLUSION:Radiotherapy for prostate cancer was associated with higher risks of developing second malignancies of the bladder, colon, and rectum compared with patients unexposed to radiotherapy, but the reported absolute rates were low. Further studies with longer follow-up are required to confirm these findings.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Wallis CJ,Mahar AL,Choo R,Herschorn S,Kodama RT,Shah PS,Danjoux C,Narod SA,Nam RKdoi
10.1136/bmj.i851subject
Has Abstractpub_date
2016-03-02 00:00:00pages
i851eissn
0959-8138issn
1756-1833journal_volume
352pub_type
杂志文章,meta分析,评审abstract:OBJECTIVE:To assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression. DESIGN:Cohort study. SETTING:Patients registered with UK general practices contributing data to the QResearch database. PARTICIPANTS:238,963 patients...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h517
更新日期:2015-02-18 00:00:00
abstract:OBJECTIVE:To investigate the psychosocial factors associated with consultation for low back pain. DESIGN:Two phase cross sectional postal survey. SETTING:Bradford Metropolitan Health District. SUBJECTS:1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7172.1564
更新日期:1998-12-05 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of corticosteroid injections with physiotherapy for the treatment of painful stiff shoulder. DESIGN:Randomised trial. SETTING:40 general practices. SUBJECTS:109 patients consulting general practitioners for shoulder pain were enrolled in the trial. INTERVENTIONS:Patients were ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.317.7168.1292
更新日期:1998-11-07 00:00:00
abstract:OBJECTIVE:To examine the effectiveness of day hospital attendance in prolonging independent living for elderly people. DESIGN:Systematic review of 12 controlled clinical trials (available by January 1997) comparing day hospital care with comprehensive care (five trials), domiciliary care (four trials), or no comprehen...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.318.7187.837
更新日期:1999-03-27 00:00:00
abstract:OBJECTIVES:To assess timeliness of carotid endarterectomy services in the United Kingdom. DESIGN:Observational study with follow-up to March 2008. SETTING:UK hospitals performing carotid endarterectomy. PARTICIPANTS:UK surgeons undertaking carotid endarterectomy from December 2005 to December 2007. MAIN OUTCOME MEA...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b1847
更新日期:2009-06-04 00:00:00
abstract:OBJECTIVES:To compare the effectiveness of an early switch to oral antibiotics with the standard 7 day course of intravenous antibiotics in severe community acquired pneumonia. DESIGN:Multicentre randomised controlled trial. SETTING:Five teaching hospitals and 2 university medical centres in the Netherlands. PARTICI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38993.560984.BE
更新日期:2006-12-09 00:00:00
abstract:OBJECTIVE:To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom. DESIGN:Guidelines were applied to population based data from a cross sectional study of cardiovascular disease and risk factors. SETTING:Newcastle upon Tyne,...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7166.1125
更新日期:1998-10-24 00:00:00
abstract:OBJECTIVES:Confirmation of breakthroughs in three different malaria chemoprophylactic regimens (chloroquine 300 mg weekly and proguanil 100 mg daily; chloroquine 300 mg weekly and proguanil 200 mg daily; proguanil 200 mg daily) and assessment of compliance. DESIGN:Prospective, randomised multicentre trial. SETTING:Fi...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.307.6911.1041
更新日期:1993-10-23 00:00:00
abstract:OBJECTIVE:To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Randomised controlled trials involving a threshold for red blood cell transfusion in hospita...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.i1351
更新日期:2016-03-29 00:00:00
abstract::A 40 year old man presents with a 1 cm tender soft swelling in the lateral neck region. This developed seven days after the onset of a tonsillitis episode that has now resolved. He has a 20 pack-year smoking history and consumes minimal alcohol. Examination is otherwise normal. ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f5473
更新日期:2013-10-28 00:00:00
abstract:OBJECTIVE:To find out whether enalapril or ramipril causes the sensitivity of the cough reflex to change or symptomatic cough to develop in patients with hypertension. DESIGN:Prospective, placebo controlled, double blind, randomised crossover study. SETTING:Academic units of clinical pharmacology and medicine. PATIE...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.299.6690.13
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVES:To investigate the cost effectiveness of cyclo-oxygenase-2 (COX 2) selective inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs), and the addition of proton pump inhibitors to these treatments, for people with osteoarthritis. DESIGN:An economic evaluation using a Markov model and data ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.b2538
更新日期:2009-07-14 00:00:00
abstract:OBJECTIVES:To determine whether over the counter cough medicines are effective for acute cough in adults. DESIGN:Systematic review of randomised controlled trials. DATA SOURCES:Search of the Cochrane Acute Respiratory Infections Group specialised register, Cochrane Controlled Trials Register, Medline, Embase, and the...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.324.7333.329
更新日期:2002-02-09 00:00:00
abstract:OBJECTIVE:To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms. DESIGN:Cohort study with data from 375 UK QResearch general practices for development and 189 for validation. PARTICIPANTS:Women aged 30-84 without a diagnosis of ovarian cancer at ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d8009
更新日期:2011-01-04 00:00:00
abstract:OBJECTIVES:To determine clinical correlates and outcome of hypoxaemia in children admitted to hospital with an acute lower respiratory tract infection. DESIGN:Prospective cohort study. SETTING:Paediatric wards of the Royal Victoria Hospital and the hospital of the Medical Research Council's hospital in Banjul, the Ga...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.318.7176.86
更新日期:1999-01-09 00:00:00
abstract:PROBLEM:Deep infection after joint arthroplasty can be catastrophic, leading to further surgery, loss of the prosthesis, disability, and risk of mortality. Twenty nine new cases of methicillin resistant Staphylococcus aureus occurred in the first year after elective orthopaedic surgery was centralised to a district gen...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.329.7458.149
更新日期:2004-07-17 00:00:00
abstract:OBJECTIVES:To compare patients' preference for transdermal fentanyl or sustained release oral morphine, their level of pain control, and their quality of life after treatment. DESIGN:Randomised, multicentre, international, open label, crossover trial. SETTING:35 centres in Belgium, Canada, Denmark, Finland, the Unite...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.322.7295.1154
更新日期:2001-05-12 00:00:00
abstract:OBJECTIVE:To compare the effects of treatments for coronavirus disease 2019 (covid-19). DESIGN:Living systematic review and network meta-analysis. DATA SOURCES:WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2020 and six additional Chinese databases up to 12 ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m2980
更新日期:2020-07-30 00:00:00
abstract:OBJECTIVE:To assess the efficacy of modest non-financial incentives on immunisation rates in children aged 1-3 and to compare it with the effect of only improving the reliability of the supply of services. DESIGN:Clustered randomised controlled study. SETTING:Rural Rajasthan, India. PARTICIPANTS:1640 children aged 1...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.c2220
更新日期:2010-05-17 00:00:00
abstract:OBJECTIVE:To investigate whether residence before and after birth near 50 Hz high voltage installations increases a child's risk of cancer and whether risk correlates with the strength of the magnetic field. DESIGN:A population based case-control study. SETTING:Denmark. SUBJECTS:1707 children under the age of 15 wit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6909.891
更新日期:1993-10-09 00:00:00
abstract::The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.308.6938.1227
更新日期:1994-05-07 00:00:00
abstract::To study a range of possible risk factors for HIV among injecting drug user patients attending a clinic in London were interviewed from November 1986 to November 1987. Serum samples were tested for viral markers. Of 116 patients, 101 had shared injecting equipment, 75 on the first occasion of injecting and 76 during t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6680.1081
更新日期:1989-04-22 00:00:00
abstract:OBJECTIVES:To document the extent to which maternity data are collected and how they are recorded, and to identify problems that may affect their availability throughout the NHS. METHODS:Postal survey in September 1997 with structured questionnaires. SETTING:207 NHS trusts with maternity units in England. PARTICIPAN...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.319.7210.619
更新日期:1999-09-04 00:00:00
abstract:OBJECTIVES:To examine the concerns of singlehanded general practitioners working in an inner London area and to compare the views of general practitioners in partnerships. DESIGN:Qualitative analysis of semistructured interviews with a random sample of singlehanded general practitioners and a sample of general practit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6904.607
更新日期:1993-09-04 00:00:00
abstract:OBJECTIVE:To investigate the impact of coexistent psychiatric morbidity on risk of suicide after a suicide attempt. DESIGN:Cohort study with follow-up for 21-31 years. SETTING:Swedish national register based study. PARTICIPANTS:39 685 people (53% women) admitted to hospital for attempted suicide during 1973-82. MAI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.a2205
更新日期:2008-11-18 00:00:00
abstract::Hepatitis B virus (HBV) is a global health problem that can lead to cirrhosis and hepatocellular carcinoma (HCC). Although HBV vaccination has reduced the prevalence Of HBV infection, the burden of disease remains high. Treatment with antiviral drugs reduces the risk of liver disease and the development of HCC, and it...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.h4263
更新日期:2015-10-21 00:00:00
abstract::The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.306.6882.901
更新日期:1993-04-03 00:00:00
abstract:OBJECTIVE:To assess the extent to which the prevailing model of smoking cessation (that smokers typically prepare their attempts to stop smoking in advance and that doing so increases their chances of success) is correct. DESIGN:Cross sectional household survey. SETTING:England. PARTICIPANTS:918 smokers who reported...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38723.573866.AE
更新日期:2006-02-25 00:00:00
abstract:OBJECTIVE:To determine if any excess of childhood leukaemia was associated with the large and increasing numbers of national military servicemen in 1949 and 1950, particularly in rural districts. This would be a further test of the hypothesis that childhood leukaemia can originate in an infection, the transmission of w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6814.1357
更新日期:1991-11-30 00:00:00
abstract:OBJECTIVE:To identify additional factors, such as maternal age or factors related to previous reproductive outcome or family history, and the corresponding probability of carrying a chromosome abnormality in couples with two or more miscarriages. DESIGN:Nested case-control study. SETTING:Six centres for clinical gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.38498.669595.8F
更新日期:2005-07-16 00:00:00