Moderate hypofractionated radiotherapy is more effective and safe for localized prostate cancer patients: a meta-analysis

Abstract

To compare the efficacy and safety of moderate hypofractionated radiotherapy (H-RT) with those of conventional radiotherapy (C-RT) in patients with localized prostate cancer, we conducted extensive literature searches of The Web of Science, Embase, Pubmed and Cochrane Library databases. We identified nine studies with 5969 patients for a meta-analysis. We calculated pooled risk ratios (RRs) and the 95% confidence intervals (CIs) for multiple parameters and performed statistical analysis using RevMan 5.3 software. Our analysis showed that the H-RT group obtained greater improvements in the 5-year biochemical or clinical failure-free survival (RR = 1.04, 95% CI:1.01–1.08; P = 0.01) and 5-year disease-free survival(RR = 1.04, 95% CI: 1.01–1.07, P = 0.02)than the C-RT group. However, the 5-year overall survival rates were comparable in the two groups (RR = 1.02, 95% CI: 0.99–1.04; P = 0.18). Comparison of multiple secondary parameters, including grade 2-4 acute/late gastrointestinal toxicity, grade 2–4 acute/late genitourinary toxicity, biochemical failure, local failure, distant failure and prostate cancer-specific mortality between the H-RT and the C-RT groups showed no statistical differences. This meta-analysis thus indicates that in patients with localized prostate cancer, moderate H-RT exerts a great beneficial effect on the primary parameters than C-RT without enhancing adverse events.

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

“…In addition, the meta-analysis included studies [19,20] which used different toxicity scales such as the '(Late Effects of Normal Tissues (LENT)' instead of the 'National Cancer Institute Common Terminology Criteria for Adverse Events', therefore it can increase heterogeneity of results. The same problem was seen with the recent meta-analysis by Cao et al [28] which reported similar acute GI toxicity with HRT and CRT, dissimilar to our analysis. However, this work contained higher heterogeneity (I 2 > 50%) which was not controlled by sub-analysis as in our study.…”

“…Randomized clinical trials with follow up of at least three months were included [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Revisions and studies that did not report the outcomes of interest or adequate data were excluded [1,[19][20][21][22][23][24][25][26][27][28].…”

<p>Moderate hypofractionated radiotherapy vs conventional fractionated radiotherapy in localized prostate cancer: a systemic review and meta-analysis from Phase III randomized trials</p>

“…However, such a follow-up is still immature in terms of cancer outcomes due to the long natural history of prostate cancer. Lastly, to our knowledge, a meta-analysis is already available in the literature from Cao et al28 However, several special aspects in this analysis are different from the study of Cao et al, including the differentiation of dose concepts with a fixed α/β ratio of 1.5 for prostate cancer and 5 for late toxicities, and thus a definition of dose escalation and no dose escalation. Moreover, exclusion of older studies with lower doses in the standard arm and the addition of newly published trials make the conclusion more dependable.…”

Exercise modulation of tumour perfusion and hypoxia to improve radiotherapy response in prostate cancer

“…Approximately 20-39% of patients with localised PCa treated with external beam radiotherapy experience local disease persistence and subsequent recurrence with an increased risk of developing distant metastases [6][7][8]. The hypoxic tumour microenvironment (TME) is recognised as a major limiting factor in the treatment of cancer and is an established prognostic marker that has been associated with treatment resistance as well as local disease persistence and recurrence [9,10].…”