Clinical Effectiveness Unit, Royal College of Surgeons, London, UK; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Clinical Effectiveness Unit, Royal College of Surgeons, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Clin Oncol (R Coll Radiol). 2020 Aug;32(8):501-508. doi: 10.1016/j.clon.2020.02.004. Epub 2020 Mar 3.
Randomised controlled trials have shown comparable early oncological outcomes after hypofractionated and conventionally fractionated radiotherapy in the radical treatment of prostate cancer (PCa). The effect of hypofractionation on treatment-related gastrointestinal and genitourinary toxicity remains uncertain, especially in older men and those with locally advanced PCa.
A population-based study of all patients treated with radical conventionally fractionated radiotherapy (n = 9106) and hypofractionated radiotherapy (n = 3027) in all radiotherapy centres in the English National Health Service between 2014 and 2016 was carried out. We identified severe gastrointestinal and genitourinary toxicity using a validated coding framework and compared conventionally fractionated and hypofractionated radiotherapy using a competing-risks proportional hazards regression analysis.
The median age in our cohort was 72 years old and most patients had locally advanced disease (65%). There was no difference in gastrointestinal toxicity (conventionally fractionated radiotherapy: 5.0 events/100 person-years; hypofractionated radiotherapy: 5.2 events/100 person-years; adjusted subdistribution hazard ratio: 1.00, 95% confidence interval: 0.89-1.13; P = 0.95) or genitourinary toxicity (conventionally fractionated radiotherapy: 2.3 events/100 person-years; hypofractionated radiotherapy: 2.3 events/100 person-years; adjusted subdistribution hazard ratio: 0.92, 95% confidence interval: 0.77-1.10; P = 0.35) between patients who received conventionally fractionated radiotherapy and those who received hypofractionated radiotherapy.
This national cohort study has shown that the use of hypofractionated radiotherapy in the radical treatment of PCa does not increase rates of severe gastrointestinal or genitourinary toxicity. Our findings also support the use of hypofractionated radiotherapy in older men and those with locally advanced PCa.
随机对照试验表明，前列腺癌（PCa）根治性治疗中，低分割放疗与常规分割放疗的早期肿瘤学结果相当。低分割放疗对治疗相关胃肠道和泌尿生殖系统毒性的影响仍不确定，尤其是在老年男性和局部晚期 PCa 患者中。
对 2014 年至 2016 年间，英国国家医疗服务体系中所有放疗中心接受根治性常规分割放疗（n=9106）和低分割放疗（n=3027）的所有患者进行了一项基于人群的研究。我们使用验证后的编码框架确定了严重的胃肠道和泌尿生殖系统毒性，并使用竞争风险比例风险回归分析比较了常规分割放疗和低分割放疗。
本队列的中位年龄为 72 岁，大多数患者患有局部晚期疾病（65%）。胃肠道毒性无差异（常规分割放疗：5.0 例/100 人年；低分割放疗：5.2 例/100 人年；调整后的亚分布危险比：1.00，95%置信区间：0.89-1.13；P=0.95）或泌尿生殖系统毒性（常规分割放疗：2.3 例/100 人年；低分割放疗：2.3 例/100 人年；调整后的亚分布危险比：0.92，95%置信区间：0.77-1.10；P=0.35）在接受常规分割放疗和低分割放疗的患者之间无差异。
本项全国性队列研究表明，在 PCa 的根治性治疗中使用低分割放疗不会增加严重胃肠道或泌尿生殖系统毒性的发生率。我们的研究结果还支持在老年男性和局部晚期 PCa 患者中使用低分割放疗。
