Department of Radiation Oncology, Duke Cancer Institute, Durham, NC 27710, USA.
Semin Radiat Oncol. 2013 Jul;23(3):191-7. doi: 10.1016/j.semradonc.2013.01.005.
This manuscript reviews the clinical evidence for hypofractionation in prostate cancer, focusing on data from prospective trials. For the purposes of this manuscript, we categorize hypofractionation as moderate (2.4-4 Gy per fraction) or extreme (6.5-10 Gy per fraction). Five randomized controlled trials have evaluated moderate hypofractionation in >1500 men, with most followed for >4-5 years. The results of these randomized trials are inconsistent. No randomized trials or other rigorous comparisons of extreme hypofractionation with conventional fractionation have been reported. Prospective single-arm studies of extreme hypofractionation appear favorable, but small sample sizes preclude precise estimates of efficacy and short follow-up prevents complication estimates beyond 3-5 years. Over the next several years, the results of 3 large noninferiority trials of moderate hypofractionation and 2 randomized trials of extreme hypofractionation should help clarify the role of hypofractionation in prostate cancer therapy.
这篇手稿回顾了前列腺癌中适形放疗的临床证据，重点关注前瞻性试验的数据。就本文的目的而言，我们将适形放疗分为中度（每次分割 2.4-4 Gy）或极端（每次分割 6.5-10 Gy）。五项随机对照试验评估了 1500 多名男性的中度适形放疗，其中大多数随访时间超过 4-5 年。这些随机试验的结果不一致。没有报道过极端适形放疗与常规分割的随机试验或其他严格比较。极端适形放疗的前瞻性单臂研究结果似乎有利，但样本量小，无法准确估计疗效，随访时间短，无法预测 3-5 年以上的并发症。在未来几年，3 项中度适形放疗的大型非劣效性试验和 2 项极端适形放疗的随机试验结果应该有助于阐明适形放疗在前列腺癌治疗中的作用。
