Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
J Urol. 2019 Mar;201(3):528-534. doi: 10.1097/JU.0000000000000071.
The aim of this guideline is to present recommendations regarding moderately hypofractionated (240-340 cGy per fraction) and ultrahypofractionated (500 cGy or more per fraction) radiation therapy for localized prostate cancer.
The American Society for Radiation Oncology convened a task force to address 8 key questions on appropriate indications and dose-fractionation for moderately and ultrahypofractionated radiation therapy, as well as technical issues, including normal tissue dose constraints, treatment volumes, and use of image guided and intensity modulated radiation therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and Society-approved tools for grading evidence quality and recommendation strength.
Based on high-quality evidence, strong consensus was reached for offering moderate hypofractionation across risk groups to patients choosing external beam radiation therapy. The task force conditionally recommends ultrahypofractionated radiation may be offered for low- and intermediate-risk prostate cancer but strongly encourages treatment of intermediate-risk patients on a clinical trial or multi-institutional registry. For high-risk patients, the task force conditionally recommends against routine use of ultrahypofractionated external beam radiation therapy. With any hypofractionated approach, the task force strongly recommends image guided radiation therapy and avoidance of nonmodulated 3-dimensional conformal techniques.
Hypofractionated radiation therapy provides important potential advantages in cost and convenience for patients, and these recommendations are intended to provide guidance on moderate hypofractionation and ultrahypofractionation for localized prostate cancer. The limits in the current evidentiary base-especially for ultrahypofractionation-highlight the imperative to support large-scale randomized clinical trials and underscore the importance of shared decision making between clinicians and patients.
本指南旨在提出关于局部前列腺癌适度适形（每分次 240-340cGy）和超适形（每分次 500cGy 或更高）放射治疗的建议。
美国放射肿瘤学会召集了一个工作组，以解决关于适度和超适形放射治疗的适当适应证和剂量分割，以及技术问题，包括正常组织剂量限制、治疗体积以及图像引导和强度调制放射治疗的使用等 8 个关键问题。建议基于系统文献回顾，并使用预定的共识制定方法和社会认可的工具来制定，这些工具用于评估证据质量和建议强度。
基于高质量证据，工作组强烈达成共识，即向选择外照射放射治疗的患者提供适用于所有风险组的中度适形治疗。工作组有条件地建议对低危和中危前列腺癌患者提供超适形放射治疗，但强烈鼓励中危患者参加临床试验或多机构注册研究。对于高危患者，工作组有条件地反对常规使用超适形外照射放射治疗。对于任何适形治疗方法，工作组强烈建议使用图像引导放射治疗，并避免使用非调制的 3 维适形技术。
适形放射治疗为患者提供了在成本和便利性方面的重要潜在优势，这些建议旨在为局部前列腺癌的中度适形和超适形治疗提供指导。当前证据基础的局限性——尤其是对于超适形治疗——突出了支持大规模随机临床试验的必要性，并强调了临床医生和患者之间共同决策的重要性。
