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Vaginal dilator therapy for women receiving pelvic radiotherapy

Pelvic radiotherapy for gynaecological (uterine, cervical, vaginal) and anorectal cancer may damage the vagina. It may cause the vagina to shrink and can make the sides stick together. It has become established practice to recommend regular vaginal dilation after radiotherapy to reduce or prevent this risk. Dilation involves inserting and rotating a phallus‐shaped appliance in the vagina approximately three times a week for about five minutes to stretch the skin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Dental extractions prior to radiotherapy to the jaws for reducing post‐radiotherapy dental complications

This review aimed to assess if removing the back teeth before radiotherapy would mean that patients had fewer tooth‐related problems after radiotherapy as part of head and neck cancer treatment, when compared to not removing the teeth. Electronic and handsearching found 357 titles of studies but none of them met the inclusion criteria for the review. There is currently no evidence available to answer this complex question.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Radiotherapy to the pelvis for cancer can damage the bladder in some, leading to late radiation cystitis

This can cause urinary problems including pain, blood in the urine and reduced bladder capacity. A cycle of bleeding, infection and occasionally life‐threatening complications can occur. Options include treating infections, blood transfusion, catheterisation, drugs inserted into the bladder, and surgery. This review found no evidence from trials to determine the effects of non‐surgical treatments for late radiation cystitis, although some drugs inserted into the bladder may be advantageous.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Radiotherapy for neovascular age‐related macular degeneration

Radiotherapy (as commonly used in the treatment of cancer) has been proposed as a treatment for wet AMD as it may prevent the growth of new vessels in the retina. This review identified 14 randomised controlled trials of radiotherapy for wet AMD. Most of these trials showed effects (not always significant) that favoured treatment with radiotherapy to prevent vision loss. However, overall this review does not provide convincing evidence that radiotherapy is an effective treatment for wet AMD, in part because the results of different trials were inconsistent, but also because it is possible that the treatment effects could be explained by the fact that it was not possible to mask the participants, and people measuring outcome, to the treatment group. The incidence of adverse effects reported in these trials was low ‐ nobody developed any radiation‐specific side effects although in three trials higher rates of cataract were reported in the radiotherapy group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Amifostine for salivary glands in high‐dose radioactive iodine treated differentiated thyroid cancer

Thyroid cancer is the most common malignancy of the endocrine system consisting of several subtypes like papillary carcinoma (accounting for 80% of cases) and follicular carcinoma (accounting for 11% of cases). These are collectively referred to as 'differentiated thyroid cancer'. Treatment with radioactive iodine after surgery (ablation of the thyroid gland or 'thyroidectomy') is important for the detection of metastatic disease and for the destruction of the remaining thyroid tissue with microscopic cancer. After radioactive iodine treatment, adverse effects may happen in the salivary glands and cause salivary gland swelling and pain, usually involving the parotid. The symptoms may develop immediately after a therapeutic dose of radioactive iodine or months later and progress in intensity with time. Secondary complications reported include dry mouth ('xerostomia') and taste alterations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Non‐surgical interventions for late rectal consequences of radiotherapy in people who have received radical radiotherapy to the pelvis

Radiotherapy is often used to treat cancer in the pelvic area. Several organs in the pelvis, such as the anus, rectum, bladder, prostate, gynaecological organs (womb, ovaries, cervix, and vagina), small bowel, and pelvic bones may be exposed to the effects of radiotherapy, which can lead to pelvic radiation disease. Symptoms from pelvic radiation disease may occur around the time of treatment (early effects) or over a period of time, often many years after treatment (late effects) due to long‐term changes secondary to scarring (fibrosis), narrowing (stenosis), and bleeding due to new blood vessel formation (telangiectasia). Damage to the rectum (radiation proctopathy) is the most often investigated late radiation effect to the pelvis, which affects a small but but still important group of people who undergo pelvic radiotherapy. The common symptoms are rectal urgency, rectal incontinence, pain, mucus discharge, and rectal bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Vaginal dilators and intercourse are useful for alleviating post‐radiotherapy vaginal problems, but more evidence is required to assess oestrogens and benzydamine

The physical side effects of radiotherapy to the female pelvis may lead to difficulty and/or pain during intercourse. Studies of treatments (vaginal oestrogens, benzydamine douches, dilators, and intercourse) were neither recent nor good quality. This review endorses the current recommendation of using dilators and/or intercourse to prevent vaginal narrowing, however although some studies recommend the use of vaginal oestrogen or benzydamine douches, they are not statistically significant and large randomized trials are required to assess their effectiveness.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Homeopathic medicines for adverse effects of cancer treatments

Homeopathic medicines are used by many patients with cancer, usually alongside conventional treatment. Cancer treatments can cause adverse effects, and one of the reasons patients use homeopathic medicines is to help with these symptoms. This review looked at whether these medicines could help patients with problems caused by cancer treatments. Eight studies with a total of 664 participants were included in this review. Three studied adverse effects of radiotherapy, three studied adverse effects of chemotherapy and two studied menopausal symptoms associated with breast cancer treatment. Two studies with low risk of bias demonstrated benefit: one with 254 participants demonstrated benefits from calendula ointment in the prevention of radiotherapy‐induced dermatitis, and another with 32 participants demonstrated benefits from Traumeel S (a complex homeopathic medicine) over placebo as a mouthwash for chemotherapy‐induced stomatitis. These trials need replicating. Two other studies reported positive results, although the risk of bias was unclear, and four further studies reported negative results. The homeopathic medicines used in all eight studies did not seem to cause any serious adverse effects or interact with conventional treatment. No cancer treatments were modified or stopped because of the homeopathic interventions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Parasympathomimetic drugs for the treatment of 'dry mouth' due to radiotherapy

This updated review found there is limited evidence to support the use of pilocarpine hydrochloride in the treatment of radiation‐induced salivary gland dysfunction ('dry mouth'). Salivary gland damage is a frequent and important complication of radiotherapy to the head and neck area; it causes dryness of the mouth with resultant problems with eating, talking, and local infection. The parasympathomimetic group of drugs have been used to treat radiotherapy‐induced salivary gland damage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Hyperbaric oxygen therapy for the treatment of the late effects of radiotherapy

There is a risk of serious complications developing after radiation treatment (radiotherapy) for cancer (late radiation tissue injury (LRTI)). These problems can be very difficult to resolve and there is some doubt as to the best approaches to treatment. Hyperbaric oxygen therapy (HBOT) involves breathing oxygen in a specially designed chamber. It is used as a treatment to improve oxygen supply to damaged tissue (cells within the body) and support healing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Do nutritional interventions reduce gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy?

Research has shown that nutrition and radiotherapy have effects on each other. People with malnutrition tend to get more bowel side effects during radiotherapy. It has also been shown that many people lose weight during radiotherapy due to the treatment side effects. These side effects can lead to some people needing gaps in their radiotherapy and sometimes they even need to stop it entirely. This can reduce the chance of cancer cure. This review looked at the literature for providing extra nourishment or changes in diet to patients before or during radiotherapy, to determine whether this is of benefit in terms of reducing bowel symptoms, improving nutritional status and quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Chinese medicinal herbs for oesophageal cancer

Chinese herbal medicine is widely used as adjunct therapy to chemo‐ or radiotherapy in patients being treated for cancer of the oesophagus. As yet there is no evidence that Chinese herbal medicine is effective or not in this role.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Fraction size in radiation therapy for breast conservation in early breast cancer

We asked if giving fewer radiation treatments (using a higher radiation dose at each visit) was as effective as the conventional 25 to 30 radiation treatments for women with early breast cancer who have breast conserving therapy (keep their breast).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Understanding tests used to detect bone problems

Just like other tissues and organs in our body, bones can be affected by medical conditions too. These include things like fractures, signs of wear and tear, inflammations and cancer. Injuries and fractures are common in younger people. As we grow older, diseases like osteoporosis and osteoarthritis are more likely to develop. Various tests and examinations can be used to find out what is causing problems like pain or difficulties moving.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 9, 2014

What is an echocardiogram?

An echocardiogram is one of the main types of routine heart examinations. It is sometimes just called an "echo test" or "heart ultrasound." It is helpful in the diagnosis of many different types of heart disease and can be done without the use of radiation.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 6, 2016

Comparing different types of scan (CT, MRI, bone scan) for diagnosis of clinically suspected scaphoid fractures, when initial radiographs are negative

This summary of a Cochrane review presents what we know from research about the accuracy of imaging tests to detect true scaphoid fractures among suspected fractures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Recurrent non-metastatic breast cancer

If breast cancer comes back, it is often more frightening than the first time it was diagnosed. But even if it does come back, there are still treatment options. It is often possible to remove the new tumor and prevent the cancer from spreading further. Daily help and support can be important in maintaining a good quality of life.Breast cancer is the uncontrollable growth of new tissue that starts in a mammary gland and then spreads. If breast cancer comes back after going away, it is known as recurrent breast cancer. That usually means that some cancer cells remained inside the body despite treatment, and that they have started to grow again. This can happen years or even decades after the first illness. Breast cancer also sometimes spreads to other parts of the body, forming distant metastatic tumors.If a new tumor grows in the breast that was already affected by cancer, it is called a local recurrence. If the breast was removed, the new tumor may start growing on the chest wall or in the skin above it. “Locoregional” means that cancer cells have also spread to tissue surrounding the breast, for example in the skin, the armpit or around the collar bone. The tumor may also have spread to neighboring lymph nodes or blood vessels. If a tumor grows in the other, previously healthy breast, it is considered to be a new, different tumor.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 27, 2017

Neck pain: Overview

Neck pain can make it difficult to move your head, and may radiate into your arms and head. The pain usually goes away after a few days or weeks, but can last much longer in some people.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 17, 2015

Breast cancer: Overview

Being diagnosed with breast cancer often makes people feel very frightened and anxious. But if you get breast cancer for the first time and it hasn’t spread far, there’s a good chance that treatment can lead to full recovery. There are also many support services that help people in everyday life, to return to work and cope emotionally with breast cancer.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 27, 2017

Testing Treatments: Better Research for Better Healthcare. 2nd edition

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Pinter & Martin.

Version: 2011

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

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