Di Franco Rossella, Borzillo Valentina, Ravo Vincenzo, Ametrano Gianluca, Falivene Sara, Cammarota Fabrizio, Rossetti Sabrina, Romano Francesco Jacopo, D'Aniello Carmine, Cavaliere Carla, Iovane Gelsomina, Piscitelli Raffaele, Berretta Massimiliano, Muto Paolo, Facchini Gaetano
Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.
Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy.
Oncotarget. 2017 Mar 7;8(10):17383-17395. doi: 10.18632/oncotarget.14798.
The aim of this review was to compare radiation toxicity in Localized Prostate Cancer (LPC) patients who underwent conventional fractionation (CV), hypofractionated (HYPO) or extreme hypofractionated (eHYPO) radiotherapy. We analyzed the impact of technological innovation on the management of prostate cancer, attempting to make a meta-analysis of randomized trials.
PubMed database has been explored for studies concerning acute and late urinary/gastrointestinal toxicity in low/intermediate risk LPC patients after receiving radiotherapy. Studies were then gathered into 5 groups: detected acute and chronic toxicity data from phase II non randomized trials were analyzed and Odds Ratio (OR) was calculated by comparing the number of patients with G0-1 toxicity and those with toxicity > G2 in the studied groups. A meta-analysis of prospective randomized trials was also carried out.
The initial search yielded 575 results, but only 32 manuscripts met all eligibility requirements: in terms of radiation-induced side effects, such as gastrointestinal and genitourinary acute and late toxicity, hypofractionated 3DCRT seemed to be more advantageous than 3DCRT with conventional fractionation as well as IMRT with conventional fractionation compared to 3DCRT with conventional fractionation; furthermore, IMRT hypofractionated technique appeared more advantageous than IMRT with conventional fractionation in late toxicities. Randomized trials meta-analysis disclosed an advantage in terms of acute gastrointestinal and late genitourinary toxicity for Hypofractionated schemes.
Although our analysis pointed out a more favorable toxicity profile in terms of gastrointestinal acute side effects of conventional radiotherapy schemes compared to hypofractionated ones, prospective randomized trials are needed to better understand the real incidence of rectal and urinary toxicity in patients receiving radiotherapy for localized prostate cancer.
本综述旨在比较接受常规分割（CV）、大分割（HYPO）或超高度大分割（eHYPO）放疗的局限性前列腺癌（LPC）患者的放射毒性。我们分析了技术创新对前列腺癌治疗管理的影响，试图对随机试验进行荟萃分析。
在PubMed数据库中检索有关低/中危LPC患者放疗后急性和晚期泌尿/胃肠道毒性的研究。然后将研究分为5组：分析II期非随机试验中检测到的急性和慢性毒性数据，并通过比较研究组中G0 - 1毒性患者与毒性> G2患者的数量计算优势比（OR）。还对前瞻性随机试验进行了荟萃分析。
初步检索产生了575条结果，但只有32篇手稿符合所有入选标准：在辐射引起的副作用方面，如胃肠道和泌尿生殖系统的急性和晚期毒性，大分割三维适形放疗（3DCRT）似乎比常规分割的3DCRT以及常规分割的调强放疗（IMRT）更具优势；此外，在晚期毒性方面，大分割IMRT技术似乎比常规分割的IMRT更具优势。随机试验荟萃分析显示，在急性胃肠道和晚期泌尿生殖系统毒性方面，大分割方案具有优势。
尽管我们的分析指出，与大分割放疗方案相比，常规放疗方案在胃肠道急性副作用方面的毒性特征更有利，但仍需要前瞻性随机试验来更好地了解接受局限性前列腺癌放疗患者直肠和泌尿毒性的实际发生率。
