Viani Gustavo Arruda, Stefano Eduardo Jose, Afonso Sergio Luis
Department of Radiation Oncology, Marilia School of Medicine, São Paulo, Brazil.
Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1405-18. doi: 10.1016/j.ijrobp.2008.10.091.
To determine in a meta-analysis whether the outcomes in men with localized prostate cancer treated with high-dose radiotherapy (HDRT) are better than those in men treated with conventional-dose radiotherapy (CDRT), by quantifying the effect of the total dose of radiotherapy on biochemical control (BC).
The MEDLINE, EMBASE, CANCERLIT, and Cochrane Library databases, as well as the proceedings of annual meetings, were systematically searched to identify randomized, controlled studies comparing HDRT with CDRT for localized prostate cancer. To evaluate the dose-response relationship, we conducted a meta-regression analysis of BC ratios by means of weighted linear regression.
Seven RCTs with a total patient population of 2812 were identified that met the study criteria. Pooled results from these RCTs showed a significant reduction in the incidence of biochemical failure in those patients with prostate cancer treated with HDRT (p < 0.0001). However, there was no difference in the mortality rate (p = 0.38) and specific prostate cancer mortality rates (p = 0.45) between the groups receiving HDRT and CDRT. However, there were more cases of late Grade >2 gastrointestinal toxicity after HDRT than after CDRT. In the subgroup analysis, patients classified as being at low (p = 0.007), intermediate (p < 0.0001), and high risk (p < 0.0001) of biochemical failure all showed a benefit from HDRT. The meta-regression analysis also detected a linear correlation between the total dose of radiotherapy and biochemical failure (BC = -67.3 + [1.8 x radiotherapy total dose in Gy]; p = 0.04).
Our meta-analysis showed that HDRT is superior to CDRT in preventing biochemical failure in low-, intermediate-, and high-risk prostate cancer patients, suggesting that this should be offered as a treatment for all patients, regardless of their risk status.
通过量化放射治疗总剂量对生化控制（BC）的影响，在一项荟萃分析中确定接受高剂量放射治疗（HDRT）的局限性前列腺癌男性患者的治疗结果是否优于接受常规剂量放射治疗（CDRT）的男性患者。
系统检索MEDLINE、EMBASE、CANCERLIT和Cochrane图书馆数据库以及年会论文集，以识别比较HDRT与CDRT治疗局限性前列腺癌的随机对照研究。为了评估剂量反应关系，我们通过加权线性回归对BC比值进行了荟萃回归分析。
确定了7项符合研究标准的随机对照试验，总患者人数为2812人。这些随机对照试验的汇总结果显示，接受HDRT治疗的前列腺癌患者生化失败发生率显著降低（p < 0.0001）。然而，接受HDRT和CDRT的组之间死亡率（p = 0.38）和前列腺癌特异性死亡率（p = 0.45）没有差异。然而，HDRT后晚期>2级胃肠道毒性病例比CDRT后更多。在亚组分析中，被分类为生化失败低风险（p = 0.007）、中风险（p < 0.0001）和高风险（p < 0.0001）的患者均显示从HDRT中获益。荟萃回归分析还检测到放射治疗总剂量与生化失败之间存在线性相关性（BC = -67.3 + [1.8 × 放射治疗总剂量（Gy）]；p = 0.04）。
我们的荟萃分析表明，在预防低风险、中风险和高风险前列腺癌患者的生化失败方面，HDRT优于CDRT，这表明无论患者的风险状态如何，都应将其作为所有患者的一种治疗方法。
