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 22 publications

(14 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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“…Therefore, RT-related genitourinary and gastrointestinal toxicities are frequently observed, and these can manifest as urinary frequency, dysuria, urgency, rectal pain, stool frequency, or rectal bleeding [15][16][17]. A recent systemic review and meta-analysis by Carvalho et al reported that the incidence of acute genitourinary and gastrointestinal toxicity was 31.9% and 21.9% in patients who underwent conventional RT [18]. Moreover, the late genitourinary and gastrointestinal toxicities were 28.0% and 16.2%, respectively.…”

Section: Plos Onementioning

confidence: 99%

Multi-criteria optimization for planning volumetric-modulated arc therapy for prostate cancer

Park

et al. 2021

PLoS ONE

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We aimed to compare the volumetric-modulated arc therapy (VMAT) plans with or without multi-criteria optimization (MCO) on commercial treatment-planning systems (Eclipse, Varian Medical System, Palo Alto, CA, USA) for patients with prostate cancer. We selected 25 plans of patients with prostate cancer who were previously treated on the basis of a VMAT plan. All plans were imported into the Eclipse Treatment Planning System version 15.6, and re-calculation and re-optimization were performed. The MCO plan was then generated. The dosimetric quality of the plans was evaluated using dosimetric parameters and dose indices that account for target coverage and sparing of the organs at risk (OARs). We defined the rectum, bladder, and bilateral femoral heads. The VMAT-MCO plan offers an improvement of gross treatment volume coverage with increased minimal dose and reduced maximal dose. In the planning treatment volume, the Dmean and better gradient, homogeneity, and conformity indexes improved despite the increasing hot and cold spots. When implemented through the MCO plan, a steeper fall off the adjacent OARs in the overlap area was achieved to obtain lower dose parameters. MCO generated better sparing of the rectum and bladder through a tradeoff of the increasing dose to the bilateral femoral heads within the tolerable dose constraints. Compared with re-optimization and re-calculation, respectively, significant dose reductions were observed in the bladder (241 cGy and 254 cGy; p<0.001) and rectum (474 cGy and 604 cGy, p<0.001) with the MCO. Planning evaluation and dosimetric measurements showed that the VMAT-MCO plan using visualized navigation can provide sparing of OAR doses without compromising the target coverage in the same OAR dose constraints.

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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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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 22 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

Multi-criteria optimization for planning volumetric-modulated arc therapy for prostate cancer

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

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