Department of Radiation Oncology, Policlinico Tor Vergata, University, Rome, Italy.
Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
Eur Urol Focus. 2017 Dec;3(6):538-544. doi: 10.1016/j.euf.2017.07.006. Epub 2017 Aug 8.
Stereotactic body radiotherapy (SBRT) is emerging as a treatment option in patients affected by oligorecurrent prostate cancer disease limited to lymph nodes, a subgroup of patients who would otherwise be treated only with androgen deprivation therapy (ADT).
To perform a systematic review of SBRT for oligorecurrent prostate cancer limited to lymph nodes.
We performed a systematic review of PubMed/Medline in October 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). We searched for studies reporting on biochemical or clinical progression and/or toxicity or complications of SBRT. Reports were excluded if these end points could not be ascertained or separately analyzed, or if insufficient details were provided.
A total of 363 patients from nine studies were collected. Of these patients, 211 were treated with SBRT for a total of 270 lymph nodes. With an alpha-beta ratio of 3 Gy, the biologically effective dose in fractionated SBRT was >100 Gy in all studies (range, 88-216 Gy). With a median follow-up of 19.23 mo, local control was achieved in 98.1% of patients. Median progression-free survival (defined as biochemical and/or radiological progression) was 22.5 mo (range, 11-30 mo). Information about ADT during SBRT was available in 281 patients, of whom 114 (40.5%) were on ADT during SBRT, and the duration of hormone therapy ranged from 1 to 17.5 mo. Median ADT-free survival was 32.8 mo (range, 25-44 mo). About toxicity, Common Terminology Criteria for Adverse Events toxicity scale was most used. Acute and/or late grade ≥2 toxicity was reported in only 5.6% of patients, and no patient developed grade 4 toxicity.
SBRT seems to be promising in lymph node oligorecurrent prostate cancer, although there is a weak level of evidence to support such investigational treatment, which is currently based on retrospective studies of single-institution or pooled experiences. ADT-free survival is an interesting end point, which needs to be investigated.
We performed a systematic review to assess outcomes and toxicity of stereotactic body radiotherapy (SBRT) for patients affected by oligorecurrent prostate cancer limited to lymph nodes. We concluded that SBRT is a promising therapy in this setting, but it needs to be validated in randomized controlled trials.
立体定向体放射治疗（SBRT）作为一种治疗方法，正在出现于局限于淋巴结的寡复发前列腺癌患者中，这是一组除了接受雄激素剥夺治疗（ADT）之外别无他法的患者。
对局限于淋巴结的寡复发前列腺癌的 SBRT 进行系统评价。
我们于 2016 年 10 月根据系统评价和荟萃分析的首选报告项目（PRISMA）对 PubMed/Medline 进行了系统评价。我们检索了报告 SBRT 治疗生化或临床进展以及/或毒性或并发症的研究。如果这些终点无法确定或无法单独分析，或者提供的细节不足，则排除报告。
共收集了 9 项研究中的 363 名患者。这些患者中，211 名接受 SBRT 治疗，共治疗 270 个淋巴结。在 α-β比为 3 Gy 的情况下，所有研究的分次 SBRT 的生物有效剂量均> 100 Gy（范围，88-216 Gy）。中位随访时间为 19.23 个月，98.1%的患者达到局部控制。中位无进展生存期（定义为生化和/或影像学进展）为 22.5 个月（范围，11-30 个月）。281 名患者中有关于 SBRT 期间 ADT 的信息，其中 114 名（40.5%）在 SBRT 期间接受 ADT，激素治疗持续时间为 1 至 17.5 个月。中位无 ADT 生存期为 32.8 个月（范围，25-44 个月）。关于毒性，最常使用不良事件常用术语标准毒性量表。仅 5.6%的患者报告了急性和/或迟发性≥2 级毒性，无患者发生 4 级毒性。
SBRT 似乎在局限于淋巴结的寡复发前列腺癌中很有前途，尽管有弱水平的证据支持这种试验性治疗，目前基于单机构或汇总经验的回顾性研究。无 ADT 生存期是一个有趣的终点，需要进一步研究。
我们进行了一项系统评价，以评估局限于淋巴结的寡复发前列腺癌患者接受立体定向体放射治疗（SBRT）的疗效和毒性。我们的结论是，SBRT 是一种很有前途的治疗方法，但需要在随机对照试验中验证。
