Department of Radiotherapy, Centre Antoine Lacassagne, University of Cote d'Azur, Nice, France.
Biostatistics Unit, Centre Antoine Lacassagne, University of Cote d'Azur, Nice, France.
Cancer Treat Rev. 2018 Nov;70:265-271. doi: 10.1016/j.ctrv.2018.10.004. Epub 2018 Oct 11.
Brachytherapy boost after external beam radiotherapy for intermediate and high-risk prostate cancer is presented as an attractive technique in numerous retrospective and prospective studies. Currently, three randomized controlled trials comparing brachytherapy versus external beam radiotherapy boost used non-homogenous irradiation features. Therefore, we analyzed the oncological outcomes by a systematic review with meta-analysis of the randomized controlled trials.
We performed a systematic literature review of MEDLINE and COCHRANE databases up to 30/04/10 and we considered all published randomized controlled trials comparing brachytherapy versus external beam radiotherapy boost for intermediate and high-risk prostate cancer according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The review was assessed using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool and the identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT). Eight publications from 3 RCTs were selected.
There was a significant benefit in 5-year biochemical-progression-free survival in favor of BT versus EBRT boost (HR: 0.49 [95% CI, 0.37-0.66], p < 0.01). There was no difference at 5 years in overall survival (HR: 0.92 [95% CI, 0.64-1.33], p = 0.65), ≥ grade 3 late genito-urinary (RR: 2.19 [95%CI, 0.76-6.30], p = 0.15) and late gastro-intestinal toxicities (RR: 1.85 [95%CI, 1.00-3.41] p = 0.05).
This meta-analysis provides further evidence in favor of BT boost for intermediate and high-risk prostate cancer in terms of b-PFS improvement, leading to suggest BT boost as level I and grade A recommendation. However, the risk of grade ≥ 3 late toxicity must be carefully investigated.
对于中高危前列腺癌，外照射放疗后进行近距离放疗加量被认为是一种很有吸引力的技术，在许多回顾性和前瞻性研究中都有报道。目前，有三项比较近距离放疗与外照射放疗加量的随机对照试验，所采用的照射技术并不完全相同。因此，我们通过系统评价和荟萃分析对这些随机对照试验进行了分析，以评估肿瘤学结果。
我们检索了 MEDLINE 和 COCHRANE 数据库，检索时间截止到 2010 年 4 月 30 日，并按照系统评价和荟萃分析的 Preferred Reporting Items for Systematic Review and Meta-analysis（PRISMA）声明，纳入了所有报道的比较中高危前列腺癌近距离放疗与外照射放疗加量的随机对照试验。通过 Assessing the Methodological Quality of Systematic Reviews（AMSTAR）工具评估研究的方法学质量，并根据 CONSORT 标准对所纳入的报告进行了评价。共纳入了 3 项随机对照试验的 8 篇文献。
在 5 年的生化无进展生存方面，近距离放疗加量明显优于外照射放疗加量（HR：0.49 [95% CI，0.37-0.66]，p<0.01）。在 5 年的总生存方面，两组没有差异（HR：0.92 [95% CI，0.64-1.33]，p=0.65），≥ 3 级的晚期泌尿生殖系统（RR：2.19 [95%CI，0.76-6.30]，p=0.15）和晚期胃肠道毒性（RR：1.85 [95%CI，1.00-3.41]，p=0.05）也没有差异。
本荟萃分析进一步支持中高危前列腺癌行近距离放疗加量，可改善生化无进展生存，提示近距离放疗加量可作为Ⅰ级和 A 级推荐。但是，必须仔细研究≥3 级晚期毒性的风险。
