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Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials
PURPOSE: To determine the efficacy and late toxicities of moderate (2.5–4 Gy) hypofractionated radiotherapy (H-RT) in localized prostate cancer, a meta-analysis of published randomized clinical trials comparing moderate H-RT with conventional fractionated RT (C-RT) was performed. MATERIALS AND METHO...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388980/ https://www.ncbi.nlm.nih.gov/pubmed/30863093 http://dx.doi.org/10.2147/OTT.S181067 |
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author | Yin, Zhenzhen You, Jinqiang Wang, Youyou Zhao, Jinlin Jiang, Shengpeng Zhang, Ximei Wang, Peiguo Tao, Zhen Wang, Xin Yuan, Zhiyong |
author_facet | Yin, Zhenzhen You, Jinqiang Wang, Youyou Zhao, Jinlin Jiang, Shengpeng Zhang, Ximei Wang, Peiguo Tao, Zhen Wang, Xin Yuan, Zhiyong |
author_sort | Yin, Zhenzhen |
collection | PubMed |
description | PURPOSE: To determine the efficacy and late toxicities of moderate (2.5–4 Gy) hypofractionated radiotherapy (H-RT) in localized prostate cancer, a meta-analysis of published randomized clinical trials comparing moderate H-RT with conventional fractionated RT (C-RT) was performed. MATERIALS AND METHODS: Systematic search on published randomized clinical trials in English according to Cochrane review guidelines in databases of Pubmed, Embase, Cochrane, web of science, and Wiley Online Library was carried out. Outcomes of interests were biochemical and clinical disease failure (BCDF), biochemical failure (BF), overall survival (OS), and late toxicities. RESULTS: Seven of the 365 studies fulfilled inclusion criteria with 8,156 participants. Compared with C-RT, moderate H-RT showed a lower BF rate (risk ratio [RR] =0.80, 95% CI: 0.68–0.95, P=0.009), while did not improve OS (RR =0.68, 95% CI: 0.78–1.02, P=0.10). There was no significant difference in BCDF rates between H-RT and C-RT (RR =0.92, 95% CI: 0.82–1.02, P=0.12). The H-RT was deeply grouped into dose-escalated H-RT (with a higher biologically effective dose [BED(1.5)] than C-RT) and no dose-escalated H-RT; dose-escalated H-RT significantly decreased BCDF rate compared with C-RT (RR =0.84, 95% CI: 0.73–0.96, P=0.01). Regarding late toxicities, there is no significant difference in late gastrointestinal (GI; RR =0.97, 95% CI: 0.71–1.33, P=0.85) and genitourinary (GU) toxicities (RR =1.04, 95% CI: 0.87–1.24, P=0.69). When subgrouped into dose-escalated H-RT (with a higher BED(5) compared with C-RT) and no dose-escalated H-RT, dose-escalated H-RT increased GI toxicity (RR =1.62, 95% CI: 1.26–2.09, P=0.0002) and GU toxicity (RR =1.28, 95% CI: 1.05–1.55, P=0.01), while no dose-escalated H-RT significantly lowered GI toxicity (RR =0.81, 95% CI: 0.70–0.94, P=0.005) and placed no influence on GU toxicity (RR =1.02, 95% CI: 0.88–1.20, P=0.77). CONCLUSION: This meta-analysis provides reliable evidence that moderate H-RT decreases BF rate, while does not improve OS. Compared with C-RT, H-RT with an increase in BED(1.5) improved BCDF rates significantly, and accordingly, an increase in BED(5) will result in elevated late GI and GU toxicities. |
format | Online Article Text |
id | pubmed-6388980 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-63889802019-03-12 Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials Yin, Zhenzhen You, Jinqiang Wang, Youyou Zhao, Jinlin Jiang, Shengpeng Zhang, Ximei Wang, Peiguo Tao, Zhen Wang, Xin Yuan, Zhiyong Onco Targets Ther Review PURPOSE: To determine the efficacy and late toxicities of moderate (2.5–4 Gy) hypofractionated radiotherapy (H-RT) in localized prostate cancer, a meta-analysis of published randomized clinical trials comparing moderate H-RT with conventional fractionated RT (C-RT) was performed. MATERIALS AND METHODS: Systematic search on published randomized clinical trials in English according to Cochrane review guidelines in databases of Pubmed, Embase, Cochrane, web of science, and Wiley Online Library was carried out. Outcomes of interests were biochemical and clinical disease failure (BCDF), biochemical failure (BF), overall survival (OS), and late toxicities. RESULTS: Seven of the 365 studies fulfilled inclusion criteria with 8,156 participants. Compared with C-RT, moderate H-RT showed a lower BF rate (risk ratio [RR] =0.80, 95% CI: 0.68–0.95, P=0.009), while did not improve OS (RR =0.68, 95% CI: 0.78–1.02, P=0.10). There was no significant difference in BCDF rates between H-RT and C-RT (RR =0.92, 95% CI: 0.82–1.02, P=0.12). The H-RT was deeply grouped into dose-escalated H-RT (with a higher biologically effective dose [BED(1.5)] than C-RT) and no dose-escalated H-RT; dose-escalated H-RT significantly decreased BCDF rate compared with C-RT (RR =0.84, 95% CI: 0.73–0.96, P=0.01). Regarding late toxicities, there is no significant difference in late gastrointestinal (GI; RR =0.97, 95% CI: 0.71–1.33, P=0.85) and genitourinary (GU) toxicities (RR =1.04, 95% CI: 0.87–1.24, P=0.69). When subgrouped into dose-escalated H-RT (with a higher BED(5) compared with C-RT) and no dose-escalated H-RT, dose-escalated H-RT increased GI toxicity (RR =1.62, 95% CI: 1.26–2.09, P=0.0002) and GU toxicity (RR =1.28, 95% CI: 1.05–1.55, P=0.01), while no dose-escalated H-RT significantly lowered GI toxicity (RR =0.81, 95% CI: 0.70–0.94, P=0.005) and placed no influence on GU toxicity (RR =1.02, 95% CI: 0.88–1.20, P=0.77). CONCLUSION: This meta-analysis provides reliable evidence that moderate H-RT decreases BF rate, while does not improve OS. Compared with C-RT, H-RT with an increase in BED(1.5) improved BCDF rates significantly, and accordingly, an increase in BED(5) will result in elevated late GI and GU toxicities. Dove Medical Press 2019-02-15 /pmc/articles/PMC6388980/ /pubmed/30863093 http://dx.doi.org/10.2147/OTT.S181067 Text en © 2019 Yin et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Review Yin, Zhenzhen You, Jinqiang Wang, Youyou Zhao, Jinlin Jiang, Shengpeng Zhang, Ximei Wang, Peiguo Tao, Zhen Wang, Xin Yuan, Zhiyong Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials |
title | Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials |
title_full | Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials |
title_fullStr | Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials |
title_full_unstemmed | Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials |
title_short | Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials |
title_sort | moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from phase iii randomized trials |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388980/ https://www.ncbi.nlm.nih.gov/pubmed/30863093 http://dx.doi.org/10.2147/OTT.S181067 |
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