Toxicity after moderately hypofractionated versus conventionally fractionated prostate radiotherapy: A systematic review and meta-analysis of the current literature,Critical Reviews in Oncology/Hematology

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Toxicity after moderately hypofractionated versus conventionally fractionated prostate radiotherapy: A systematic review and meta-analysis of the current literature
Critical Reviews in Oncology/Hematology ( IF 5.5 ) Pub Date : 2021-08-03 , DOI: 10.1016/j.critrevonc.2021.103432
G Francolini ₁ , B Detti ₁ , C Becherini ₁ , S Caini ₂ , G Ingrosso ₃ , Vanessa Di Cataldo ₁ , G Stocchi ₁ , V Salvestrini ₁ , A Lancia ₄ , D Scartoni ₅ , I Giacomelli ₅ , A Sardaro ₆ , R Carbonara ₇ , S Borghesi ₈ , C Aristei ₃ , L Livi ₁

Affiliation

Background

Moderately hypofractionated radiotherapy (RT) currently represents the standard RT approach for all prostate cancer (PCa) risk categories. We performed a systematic review and meta-analysis of available literature, focusing on acute and late genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) of moderate hypofractionation for localized PCa.

Materials and methods

Literature search was performed and two independent reviewers selected the records according to the following Population (P) Intervention (I) Comparator (C) and Outcomes (O) (PICO) question: “In patients affected by localized PCa (P), moderately hypofractionated RT (defined as a treatment schedule providing a single dose per fraction of 3–4.5 Gy) (I) can be considered equivalent to conventionally fractionated RT (C) in terms of G > 2 GI and GU acute and late adverse events (O)?”. Bias assessment was performed using Cochrane Cochrane Collaboration's Tool for Assessing Risk of Bias.

Results

Thirteen records were identified and a meta-analysis was performed. Risk of acute GI and GU > 2 adverse events in the moderately hypofractionated arm was increased by 9.8 % (95 %CI 4.8 %–14.7 %; I² = 57 %) and 1.5 % (95 % CI -1.5 %-4.4 %; I² = 0%), respectively.

Discussion

Overall, majority of trials included in our meta-analysis suggested that moderately hypofractionated RT is equivalent, in terms of GI and GU adverse events, to conventional fractionation. Pooled analysis showed a trend to increased GI toxicity after hypofractionated treatment, but this might be related to dose escalation rather than hypofractionation.

中文翻译：

中度大分割与常规分割前列腺放疗后的毒性：当前文献的系统评价和荟萃分析

背景

中等大分割放疗 (RT) 目前代表所有前列腺癌 (PCa) 风险类别的标准放疗方法。我们对现有文献进行了系统回顾和荟萃分析，重点关注局部 PCa 中度大分割的急性和晚期泌尿生殖 (GU) 和胃肠 (GI) 不良事件 (AE)。

材料和方法

进行了文献检索，两名独立审查员根据以下人群 (P) 干预 (I) 比较器 (C) 和结果 (O) (PICO) 问题选择了记录：“在受局部 PCa (P) 影响的患者中，中度大分割在 G > 2 GI 和 GU 急性和晚期不良事件 (O)方面，放疗（定义为每分次提供单次剂量 3–4.5 Gy 的治疗计划）(I) 可被认为等同于常规分次放疗 (C ) ？”。使用 Cochrane Cochrane Collaboration's Tool for Assessing Risk of Bias 进行偏倚评估。