A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer

Wolff, Robert; Ryder, Steve; Bossi, Alberto; Briganti, Alberto; Crook, Juanita; Henry, Ann; Karnes, Jeffrey; Potters, Louis; Reijke, Theo de; Stone, Nelson N.; Burckhardt, Marion; Duffy, Steven; Worthy, Gillian; Kleijnen, Jos

doi:10.1016/j.ejca.2015.07.019

Cited by 79 publications

(57 citation statements)

References 139 publications

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“…With respect to Key Question 1, there are no RT studies that use OS, DM, or PCSM as a primary endpoint in the localized setting; rather FFBF is used as a surrogate endpoint because there is a relatively long natural history of prostate cancer, with a long delay between BF, DM, and CSM [49,50]. The 5-year FFBF rate among a few of the trials has been above 90% [7,19] (Supplementary Tables 3 and 4).…”

Section: Key Question 1: Psa Kineticsmentioning

confidence: 99%

“…External beam RT is used in about 25% of patients younger than 65 years, and almost half of patients older than 65 years [63]. Since the 1990s, there have been two central themes in localized prostate cancer external beam RT RCTs [49,50], summarized in Supplementary Table 3. The first theme has been escalation of the total dose with conventionally fractionated RT [7][8][9][10][11][12][13][14], from 66 Gy to 70 Gray (Gy), up to a total of 76 to 80 Gy in 1.8-2 Gy fractions.…”

Section: Key Question 1: Psa Kineticsmentioning

confidence: 99%

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Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer

Zaorsky

Shaikh

Murphy

et al. 2016

Cancer Treatment Reviews

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We review radiation therapy (RT) options available for prostate cancer, including external beam (EBRT; with conventional fractionation, hypofractionation, stereotactic body RT [SBRT]) and brachytherapy (BT), with an emphasis on the outcomes, toxicities, and contraindications for therapies. PICOS/PRISMA methods were used to identify published English-language comparative studies on PubMed (from 1980 to 2015) that included men treated on prospective studies with a primary endpoint of patient outcomes, with ⩾70 patients, and ⩾5year median follow up. Twenty-six studies met inclusion criteria; of these, 16 used EBRT, and 10 used BT. Long-term freedom from biochemical failure (FFBF) rates were roughly equivalent between conventional and hypofractionated RT with intensity modulation (evidence level 1B), with 10-year FFBF rates of 45-90%, 40-60%, and 20-50% (for low-, intermediate-, and high-risk groups, respectively). SBRT had promising rates of BF, with shorter follow-up (5-year FFBF of >90% for low-risk patients). Similarly, BT (5-year FFBF for low-, intermediate-, and high-risk patients have generally been >85%, 69-97%, 63-80%, respectively) and BT+EBRT were appropriate in select patients (evidence level 1B). Differences in overall survival, distant metastasis, and cancer specific mortality (5-year rates: 82-97%, 1-14%, 0-8%, respectively) have not been detected in randomized trials of dose escalation or in studies comparing RT modalities. Studies did not use patient-reported outcomes, through Grade 3-4 toxicities were rare (<5%) among all modalities. There was limited evidence available to compare proton therapy to other modalities. The treatment decision for a man is usually based on his risk group, ability to tolerate the procedure, convenience for the patient, and the anticipated impact on quality of life. To further personalize therapy, future trials should report (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education status; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics.

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Section: Key Question 1: Psa Kineticsmentioning

confidence: 99%

Section: Key Question 1: Psa Kineticsmentioning

confidence: 99%

Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer

Zaorsky

Shaikh

Murphy

et al. 2016

Cancer Treatment Reviews

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“…5 However, a recent systematic review could not provide strong evidence to support one therapy over another for the treatment of localized prostate cancer. 6 Using the United States National Cancer Database, Marsh and colleagues compared survival in 455 106 men with stage II prostate cancer treated with either EBRT (n=169 185) or radical prostatectomy (n=285 921). 7 Patients who underwent radical prostatectomy were on average younger than those who underwent EBRT (60.56 years vs. 69.42 years; p<0.05) and had a higher average PSA level (11.82 ng/mL vs. 7.67 ng/mL; p<0.05).…”

Section: Shorter Radiation Fractionation Regimen Is Not Inferior To Cmentioning

confidence: 99%

Localized prostate cancer

Kapoor

Hotte

2016

CUAJ

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“…A recent systematic review by Wolff et al of limited, randomized data demonstrated no significant difference in biochemical progression-free survival in patients with low-to intermediate-risk prostate cancer treated with brachytherapy or radical prostatectomy. 1 Patients treated with brachytherapy, however, reported better preservation of sexual function, but worse short-term (<5 years) urinary function.…”

mentioning

confidence: 96%

“…1 Active surveillance with delayed curative intent is becoming a favoured approach and standard of care for appropriate men with low-and select intermediate-risk prostate cancers. Patients should continue to be counselled regarding accepted treatment options complete with cancer-related outcomes, potential adverse effects, and need for additional therapy in order to make an informed decision.…”

mentioning

confidence: 99%