Table 1.
Summary of Studies Reviewed in Which Diagnostic or Nondiagnostic Biopsies Were Performed Immediately Before, During, or After Radiation Therapy
| Site | First Author | Cancer Type | Bx Type and Site | No. of Patients | RT Characteristics | Bx Timing in Relation to RT | Reported AE of Bx |
|---|---|---|---|---|---|---|---|
| Genitourinary | Birkenhake24 | Bladder | Repeat TURBT | 25 | 54 Gy + 5.4 Gy boost to bladder | Before: TURBT; After: 6-8 weeks post CRT | AE reported: None attributed to bx |
| Cowan25 | Bladder | Cystoscopy with bx of lesions after initial TURBT | ≥ 62 | Range: 50-57.5 Gy | Before: TURBT; After: within 4 months | AE reported: None attributed to bx | |
| Hagan26 | Bladder | Cystoscopy and tumor bed bx after initial TURBT | 47 | 40.8 Gy BID; concomitant boost days 1-16 ± additional 24 Gy | Before: TURBT; During: 3 weeks post initial CRT; After: within 6 weeks of all treatment | AE reported: None attributed to bx | |
| Kachnic27 | Bladder | Cystoscopy and tumor bed bx after initial TURBT | 97 | Initial = 39.6 Gy; Total = 63.8 Gy | Before: TURBT; During: after initial CRT; After: within 3 months of completion of CRT | AE reported: None attributed to bx | |
| Kaufman28 | Bladder | Cystoscopy and tumor bed bx after initial TURBT | 33 | Initial = 24 Gy; Total = 44 Gy | Before: TURBT; During: 4 weeks post initial CRT; After: within 3 months | AE reported: None attributed to bx | |
| Rödel29 | Bladder | Repeat TURBT | 39 | Negative margins = 54 Gy; positive margins = 59.4 Gy | Before: TURBT; After: 6-8 weeks post CRT | AE reported: None attributed to bx | |
| Shipley30 | Bladder | Cystoscopy and tumor bed bx after initial TURBT | 51 | Initial = 39.6 Gy; Total = 64.8 Gy | Before: TURBT; During: 4 weeks post initial CRT | AE reported: None attributed to bx | |
| Tester31 | Bladder | Cystoscopy and tumor bed bx after initial TURBT | 42 | Initial = 39.6 Gy; Total = 64.8 Gy | Before: TURBT; During: 2 weeks post initial CRT | No comments on AE | |
| Tester32 | Bladder | Cystoscopy and tumor bed bx after initial TURBT | 85 | Initial = 39.6 Gy; Total = 64.8 Gy | Before: TURBT; During: 2 weeks post initial CRT | AE reported: None attributed to bx | |
| Cerciello33 | Cervical | Cervical tumor bx | 40 | 4 different regimens; medians range from 40 to 96 Gy | Before: pretreatment bx; During: after 1 week of RT (5 fractions = 9 Gy) | No comments on AE | |
| Durand34 | Cervical | Cervical tumor bx | 41 | EBR 45 Gy ± Brachytherapy (27 Gy) ± additional EB ± CT | Before: pretreatment bx; During: every week on treatment | AE reported: None attributed to bx | |
| Iwakawa35 | Cervical | Cervical tumor bx | 39 | 50.6 Gy + high dose brachytherapy | Before: pretreatment bx; During: after 1 week of RT (5 fractions = 9 Gy) | No comments on AE | |
| Ohno36 | Cervical | Cervical tumor bx | 20 | 50.6 Gy + high dose brachytherapy (22-24 Gy) | Before: pretreatment bx; During: after 1 week of RT (5 fractions = 9 Gy) | No comments on AE | |
| Head and Neck | Tessa37 | Esophageal | Esophagoscopy with nonmandatory bx | ≥ 14 | 60 Gy ± brachytherapy boost (7-28 Gy) | Before: diagnostic bx; After: 1-2 months after RT | AE reported: None attributed to bx |
| Samant38 | PSC | Panendoscopy and tumor bx | 25 | Range: 68-74 Gy | After: 2 months after RT | AE reported: None attributed to bx | |
| Samant39 | Head/Neck | Bx of irradiated region | 25 | Range: 66-74 Gy | After: 8 weeks after RT | AE reported: None attributed to bx | |
| Wanebo40 | Head/Neck | Bx of irradiated region | 38 | Initial = 45 Gy; Total = 72 Gy | During: 5 weeks after RT | AE reported: None attributed to bx | |
| Wanebo41 | Head/Neck | Bx of irradiated region | 28 | Initial = 50 Gy; Total = 68-72 Gy | After: 8 weeks post initial CT; 14 weeks post CRT | AE reported: None attributed to bx | |
| Kam42 | NPC | Flex endoscopy and tumor bx | 63 | IMRT = 66 Gy + ICB boost (12 Gy) for T1-T2a; ± conformal boost (8 Gy) for T2b-4 | Before: pretreatment bx; After: 6-12 weeks post RT | AE reported: None attributed to bx | |
| Kwong43 | NPC | Endoscopy and ≥ 6 irradiated nasopharynx bx | 803 | Median = 61 Gy; Range = 59.5-74 Gy | After: immediately post RT, repeated every 2 weeks until bx were negative | No AE in median 47 months of follow-up | |
| Tsai44 | NPC | Bx of irradiated nasopharynx | 25 | ≥ 70 Gy | After: within 4 months | No comments on AE | |
| Lung | Cerfolio45 | NSSLC | EUS-FNA of mediastinal lymph nodes | 93 | RT with carboplatinum-based CT | Before: before CRT; After: 5.9 weeks (4.1-10.3) post CRT | No comments on AE |
| Gastrointestinal | Capirci46 | Rectal | Proctoscopy with multiple rectal bx | 81 | 3 fields: 50 Gy, 53 Gy and 56 Gy | Before: before CRT; After: 4 weeks after CRT | No comments on AE |
| Willett47 | Rectal | Proctoscopy with rectal bx | 22 | EBR | Before: 12 days after bevacizumab infusion, immediately before RT | No comments on AE | |
| Flam48 | Anal | Full thickness anal bx, pretreatment inguinal node aspiration and/or excision | 262 (initial); 22 (repeat) | Initial = 45 Gy; (50.4 Gy boost for positive nodes); Salvage = 9 Gy | Before: nodal bx; During: 4-6 weeks after initial CRT; After: 6 weeks after salvage RT | AE reported: None attributed to bx | |
| Hovdenak49 | Pelvic | Proctoscopy with multiple rectal bx | 33 | Range: 54-66 Gy | Before: pretreatment bx; During: 2 weeks and 6 weeks during RT | No comments on AE | |
| Sedgwick50 | Pelvic | Sigmoidoscopy and anterior and posterior rectal wall bx | 9 | Range: 50-52.6 Gy | During: weeks 2 and 4 during RT; After: 4 and 12 weeks post RT | Ulceration and failure of healing at bx sites | |
| Breast | Pezner51 | Breast | Both open (n = 27) and percutaneous needle (n = 11) breast bx after breast preserving surgery | 31 | 50 Gy ± 5 to 30 Gy Boost | Open = 2-81 months after RT; Needle = 1-52 months after RT | 30% open bx had infection/delayed healing; no AE in needle bx |
| Other | Morstyn52 | Breast (1); Melanoma (2) | Skin (n = 2), breast (n = 1), melanoma (n = 1), and bone marrow (n = 1) bx | 3 | Variable RT doses and treatment | Before and during RT | No comments on AE |
Abbreviations: bx, biopsy; RT, radiation therapy; AE, adverse events; TURBT, transurethral resection of bladder tumor; CRT, chemoradiotherapy; BID, twice daily; EBR, external beam radiation; IMRT, intensity-modulated radiation therapy; ICB, intracavitary brachytherapy; PSC, pyriform sinus carcinoma; NPC, nasopharyngeal carcinoma; NSSLC, non–small-cell lung cancer; EUS-FNA, endoscopic ultrasonography.