Genitourinary and gastrointestinal toxicity among patients with localized prostate cancer treated with conventional versus moderately hypofractionated radiation therapy: systematic review and meta-analysis

Carvalho, Icaro Thiago de; Baccaglini, Willy; Claros, Oliver Rojas; Chen, Felipe K.; Kayano, Paulo Priante; Lemos, Gustavo Caserta; Weltman, Eduardo; Kuban, Deborah A.; Carneiro, Ariê

doi:10.1080/0284186x.2018.1478126

Cited by 20 publications

(12 citation statements)

References 36 publications

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“…For HDR+EBRT, Ishiyama et al reported 5-and 10-year accumulated rates of late Grade ≥2 GU toxicities were 16.7% and 26.7% in 3424 Asian patients [10]. Our data (Conv EBRT 9.2% and 13.8%, HDEBRT 5.6% and not available, HDR +EBRT 10.5%, and 23% at 5-and 10-years) concurred to Japanese and Asian data and it seems lower than the previous review [31].…”

Section: Discussionsupporting

confidence: 82%

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Radiotherapy for Clinically Localized T3b or T4 Very-High-Risk Prostate Cancer-Role of Dose Escalation Using High-Dose-Rate Brachytherapy Boost or High Dose Intensity Modulated Radiotherapy

Yamazaki

Suzuki

Masui

et al. 2021

Cancers

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To examine the efficacy of dose escalating radiotherapy into patients with cT3b or T4 localized prostate cancer, we compared Group A (86 conventional dose external beam radiotherapy: EBRT group, treated with 70–72Gy) and group B (39 high dose EBRT group (HDEBRT group, 74–80 Gy) and 124 high-dose-rate brachytherapy (HDR) + EBRT (HDR boost)) using multi-institutional retrospective data. The actuarial 5-year biochemical disease-free survival (bDFS) rate, prostate cancer specific survival rate (PSS), and overall survival rate (OS) were 75.8%, 96.8%, and 93.5%. Group B showed superior 5-year bDFS rate (81.2%) as compared to the group A (66.5%) (p < 0.0001) with a hazard ratio of 0.397. Equivocal 5-year PSS (98.3% and 94.8% in group B and group A) and OS (both 93.7%) were found between those groups. Accumulated late grade ≥2 toxicities in gastrointestinal and genitourinary tracts were similar among those three groups. Therefore, both HDEBRT and HDR boost could be good options for improving the bDFS rate in cT3–T4 localized prostate cancer without affecting PSS and OS.

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Section: Discussionsupporting

confidence: 82%

“…For GU toxicity, Carvalho, et al made a systematic review and meta-analysis and reported around 28% of late GU toxicity at 12 months or more after EBRT [31]. Takemoto reported 7.9-12.4% of GU Grade ≥2 ratio at 6-10 years using IMRT in Japan [32].…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy for Clinically Localized T3b or T4 Very-High-Risk Prostate Cancer-Role of Dose Escalation Using High-Dose-Rate Brachytherapy Boost or High Dose Intensity Modulated Radiotherapy

Yamazaki

Suzuki

Masui

et al. 2021

Cancers

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“…Nevertheless, there always has been a concern about possible late adverse effects linked to HFRT. Several studies have shown statistically similar late toxicity rates between the two fractionation schedules [39,40]. However, Alluwini et al, who used the highest EQD2 (90.4 Gy), reported an increased cumulative incidence of late GI toxicity (stool frequency) grade ≥ 2 (1.19 Hazard Ratio (HR) [95% CI 0.93-1.52]) and an increased cumulative incidence of late GU toxicity (frequency, nocturia and incontinence) grade ≥ 3 with HFRT versus CFRT (19.0% [95% CI 15.2-23.2] vs. 12.9% [9.7-16.7], respectively; p = 0.021) [22].…”

Section: Discussionmentioning

confidence: 98%

Long-Term Outcomes of Dose-Escalated Hypofractionated Radiotherapy in Localized Prostate Cancer

Lazo

Torre‐Luque

Arregui³

et al. 2022

Biology

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This retrospective study aimed to provide some clinical outcomes regarding effectiveness, toxicity, and quality of life in PCa patients treated with dose-escalated moderately hypofractionated radiation therapy (HFRT). Patients received HFRT to a total dose of 66 Gy in 22 fractions (3 Gy/fraction) delivered via volume modulated arc therapy (VMAT) in 2011–2016. Treatment effectiveness was measured by the biochemical failure-free survival rate. Toxicity was assessed according to the criteria of the Radiation Therapy Oncology Group (RTOG) and quality of life according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC). In this regard, quality of life (QoL) was measured longitudinally, at a median of 2 and 5 years after RT. Enrolled patients had low-risk (40.2%), intermediate-risk (47.5%), and high-risk (12.3%) PCa. Median follow-up was 75 months. The biochemical failure-free survival rate was 94.2%. The incidence of acute grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicity was 9.84% and 28.69%, respectively. The incidence rate of late grade 2 or higher GI and GU toxicity was 1.64% and 4.10%, respectively. Expanded Prostate Cancer Index Composite (EPIC) scores showed that the majority of patients maintained their QoL. HFRT to 66 Gy with VMAT was associated with adequate biochemical control, low toxicity and good reported GU and GI quality of life.

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“…The shorter treatment course is more convenient to many patients who reside far away from the radiotherapy facility. Second, many studies have demonstrated that the treatment costs of SBRT are lower than those of CFRT (37)(38)(39). This would be cost effective and encourage patients to receive treatment.…”

Section: Discussionmentioning

confidence: 99%

Whole Pelvic Radiotherapy With Stereotactic Body Radiotherapy Boost vs. Conventionally Fractionated Radiotherapy for Patients With High or Very High-Risk Prostate Cancer

Wang

Ting²,

Chang

et al. 2020

Front. Oncol.

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Background: Whole pelvic radiotherapy (WPRT) with stereotactic body radiotherapy (SBRT) boost has been shown to be effective in patients with high-risk prostate cancer (PC). However, no study has directly compared the efficacy of WPRT with SBRT boost with that of conventionally fractionated radiotherapy (CFRT). We compared the clinical outcomes between CFRT and WPRT with SBRT boost in patients with high or very high-risk PC (National Comprehensive Cancer Network definition). Methods: In total, 132 patients treated with CFRT and 121 patients treated with WPRT followed by SBRT boost were retrospectively analyzed. For the CFRT group, the prescribed dose range was 74-79.2 Gray (Gy) administered at 1.8-2 Gy per fraction. For WPRT with SBRT boost, the prescribed doses were 45 Gy administered in 25 fractions to the whole pelvis followed by 21 Gy boost (3 fractions of 7 Gy each) to prostate and seminal vesicles. The overall survival (OS) and biochemical failure (Phoenix definition) free survival (bFFS) were assessed by using the Kaplan-Meier method or the Cox proportional hazards regression model. The gastrointestinal (GI) and genitourinary (GU) tract toxicity were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Results: The estimated 4-years overall survival in the CFRT and WPRT with SBRT boost groups was 91.6 and 97.7%, respectively (P = 0.18). The estimated 4-years biochemical failure-free survival in the CFRT and WPRT with SBRT boost groups was 89.1 and 93.9%, respectively (P = 0.41). No acute grade 3 or higher GI and GU toxicity was observed in both groups. Late grade 3 GI and GU toxicity occurred in 2.3 and 2.3% in the CFRT group, and in 1.7 and 0.8% in the WPRT with SBRT boost group, respectively. There was no significant between-group difference with respect to acute or late toxicity. Wang et al. SBRT Boost for Prostate Cancer Conclusions: In patients with high or very high-risk localized PC, compared with CFRT, WPRT with SBRT boost resulted in similar biochemical-free and overall survival rate with minimal toxicity. WPRT with SBRT boost is a feasible option for patients with high or very high-risk PC.

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Genitourinary and gastrointestinal toxicity among patients with localized prostate cancer treated with conventional versus moderately hypofractionated radiation therapy: systematic review and meta-analysis

Abstract: In meta-analysis of the available randomized trials on moderate HRT versus CRT for prostate cancer, acute and late GU toxicity were similar for both treatment schemes. While HRT was associated with higher acute GI toxicity, late toxicity was similar.

Cited by 20 publications

References 36 publications

Radiotherapy for Clinically Localized T3b or T4 Very-High-Risk Prostate Cancer-Role of Dose Escalation Using High-Dose-Rate Brachytherapy Boost or High Dose Intensity Modulated Radiotherapy

Radiotherapy for Clinically Localized T3b or T4 Very-High-Risk Prostate Cancer-Role of Dose Escalation Using High-Dose-Rate Brachytherapy Boost or High Dose Intensity Modulated Radiotherapy

Long-Term Outcomes of Dose-Escalated Hypofractionated Radiotherapy in Localized Prostate Cancer

Whole Pelvic Radiotherapy With Stereotactic Body Radiotherapy Boost vs. Conventionally Fractionated Radiotherapy for Patients With High or Very High-Risk Prostate Cancer

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