Introduction
High-dose-rate (HDR) brachytherapy as primary therapy (monotherapy) is a standard National Comprehensive Cancer Network (NCCN) endorsed treatment option for patients with localized prostate cancer. Thus far, most data are limited to single-institution experiences. Accordingly, we sought to systematically review rates of biochemical recurrence-free survival (bRFS) and toxicity associated with fractionated HDR monotherapy.

Material and methods
A systematic review was performed using PubMed and Embase databases for relevant articles published between January 1999 and December 2019, according to preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. Included studies were limited to fractionated HDR monotherapy publications in full manuscript form with at least 5-year median follow-up, at least 80 patients included, and adequate reporting of bRFS and toxicity data. Meta-analyses were performed with random-effect modeling. Extent of heterogeneity between studies was determined using I2 and Cochran’s Q tests.

Results
Seven unique studies were identified, including 2,123 patients. NCCN low-, intermediate-, and high-risk patients comprised 40%, 40%, and 20% of patients, respectively. Median follow-up at the study group level was 74 months (range, 60-131 months). The 5-year bRFS rate was 95% (95% confidence interval [CI]: 93-96%), and after adjusting to control for publication bias, it was 96% (95% CI: 94-99%). Estimated adjusted late grade ≥ 3 genitourinary and gastrointestinal toxicity rates were 2% (95% CI: 1-4%) and 0.3% (95% CI: 0-1.1%), respectively.

Conclusions
Fractionated HDR monotherapy is associated with high rates of disease control and low rates of toxicity. Future studies are needed to better define the value of this treatment modality relative to other options.



中文翻译：

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局部前列腺癌的高剂量分割近距离放射治疗单一疗法：系统评价和荟萃分析

简介
高剂量率 (HDR) 近距离放射治疗作为主要治疗（单一疗法）是国家综合癌症网络 (NCCN) 认可的标准治疗方案，适用于局限性前列腺癌患者。到目前为止，大多数数据仅限于单一机构的经验。因此，我们试图系统评价与分次 HDR 单药治疗相关的生化无复发生存率 (bRFS) 和毒性。

材料与方法
根据系统评价和荟萃分析 (PRISMA) 指南的首选报告项目，使用 PubMed 和 Embase 数据库对 1999 年 1 月至 2019 年 12 月期间发表的相关文章进行了系统评价。纳入的研究仅限于完整手稿形式的分级 HDR 单一疗法出版物，中位随访时间至少为 5 年，包括至少 80 名患者，并充分报告了 bRFS 和毒性数据。使用随机效应模型进行荟萃分析。使用 I2 和 Cochran 的 Q 检验确定研究之间的异质性程度。

结果
确定了七项独特的研究，包括 2,123 名患者。NCCN 低危、中危和高危患者分别占患者的 40%、40% 和 20%。研究组水平的中位随访时间为 74 个月（范围为 60-131 个月）。5 年 bRFS 率为 95%（95% 置信区间 [CI]：93-96%），调整以控制发表偏倚后为 96%（95% CI：94-99%）。估计调整后的晚期 ≥ 3 级泌尿生殖系统和胃肠道毒性发生率分别为 2%（95% CI：1-4%）和 0.3%（95% CI：0-1.1%）。

结论
分次 HDR 单药治疗与疾病控制率高和毒性发生率低相关。未来的研究需要更好地定义这种治疗方式相对于其他选择的价值。