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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Immunosuppressive treatment and radiotherapy in kidney transplant patients: A systematic review
Valentina Lancellotta, Andrea D'Aviero, Bruno Fionda, Calogero Casà, Ilaria Esposito, Francesco Preziosi, Anna Acampora, Fabio Marazzi, György Kovács, Barbara Alicja Jereczek-Fossa, Alessio Giuseppe Morganti, Vincenzo Valentini, Maria Antonietta Gambacorta, Jacopo Romagnoli, Luca Tagliaferri
Valentina Lancellotta, Andrea D'Aviero, Bruno Fionda, Calogero Casà, Ilaria Esposito, Francesco Preziosi, Fabio Marazzi, Vincenzo Valentini, Maria Antonietta Gambacorta, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
Anna Acampora, Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome 00168, Rome, Italy
György Kovács, Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, 00168 Rome, Italy
Barbara Alicja Jereczek-Fossa, Department of Oncology and Hemato-oncology, European Institute of Oncology, University of Milan, Milan 20141, Italy
Alessio Giuseppe Morganti, Radiotherapy Center, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40121, Italy
Jacopo Romagnoli, Luca Tagliaferri, Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
Author contributions: Valentini V, Morganti AG, Tagliaferri L, and Romagnoli J contributed to scientific committee; Acampora A, Lancellotta V, and Tagliaferri L contributed to working group performing literature review and summary for experts; Romagnoli J, Marazzi F, Preziosi F, Casà C, and Esposito I contributed to resolve uncertainty regarding eligibility; Kovács G, Jereczek-Fossa A, and Gambacorta MA contributed to revise the manuscript.
Conflict-of-interest statement: the authors reported no potential competing interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bruno Fionda, MD, Doctor, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Romre 00168, Rome, Italy. bruno.fionda@yahoo.it
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: December 10, 2021
Revised: December 20, 2021
Accepted: March 15, 2022
Article in press: March 15, 2022
Published online: March 28, 2022
Processing time: 164 Days and 23.4 Hours
BACKGROUND
Immunosuppression (IS) therapy may contribute to cancer development. Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections, in immunosuppression-related diseases, and in patients undergoing radiotherapy. The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.
AIM
To define if it is necessary reduce immunosuppression drugs during radiotherapy.
METHODS
The literature search was based on three electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords linked through the "AND" and "OR" Boolean operators to build specific strings for each electronic search engine. Two researchers independently screened the citations, and disagreement was resolved by discussion or through the intervention of a third author. The review was conducted and reported according to the PRISMA statement. Extracted data were narratively synthesized, and, where possible, frequencies, percentages, and ranges were calculated.
RESULTS
The literature search resulted in 147 citations. After abstracts screening, 21 records were selected for full-text evaluation. Fifteen of these were excluded, leaving six papers considered suitable for analysis. There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors, as opposed to continuing maintenance IS, improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy. Only few retrospective studies on small cancer patient cohorts are available in this setting, but without comparison of different immunosuppression treatments. Even where immunosuppression therapy was described, patient survival seemed to be correlated only with cancer stage and type.
CONCLUSION
The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.
Core Tip: This systematic review aimed to define the need of immunosuppressive therapy modulation during radiotherapy. There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy. Even where immunosuppression therapy was described, patient survival seemed to be correlated only with cancer stage and type. The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.
