Wang Shilin, Tang Wen, Luo Huanli, Jin Fu, Wang Ying
Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing 400030, People's Republic of China.
Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People's Republic of China.
Clin Transl Radiat Oncol. 2022 Nov 8;38:81-89. doi: 10.1016/j.ctro.2022.11.001. eCollection 2023 Jan.
Image-guided radiotherapy (IGRT) has gradually been widely promoted in clinical procedure. However, there has been no consensus on the effects of IGRT on toxicity and survival, and no clear level 1 evidence has even been promulgated.
Medline, EMBASE, PubMed, Cochrane databases and ClinicalTrials.gov were searched for studies comparing IGRT vs non-IGRT or higher frequency IGRT vs lower frequency IGRT during prostate radiotherapy, indexed from database inception to April 2022.
The review included 18 studies (3 randomized clinical trial and 15 cohort studies) involving 6521 men, with a median duration of patient follow-up of 46.2 months in the IGRT group vs 52.7 months in the control group. The -analysis demonstrated that IGRT significantly reduced acute GU (risk ratio [RR], 0.78; 95 % confidence interval [CI], 0.69-0.88; < 0.001 [9 studies]) and GI toxicity (RR, 0.49; 95 % CI, 0.35-0.68; < 0.001 [4 studies]) and late GI toxicity (HR, 0.25; 95 % CI, 0.07-0.87; = 0.03 [3 studies]) compared with non-IGRT. Meanwhile, compared with prospective studies, retrospective studies showed that IGRT had a more significant effect in reducing the late GI toxicity. Compared with non-daily IGRT, daily IGRT significantly improved 3-year PRFS (HR, 0.45; 95 % CI, 0.28-0.72; = 0.001 [2 studies]) and BFFS (HR, 0.57; 95 % CI, 0.39-0.83; = 0.003 [3 studies]). Furthermore, high-frequency daily IGRT could lead to greater 3-year BFFS benefit in prostate cancer patients than weekly IGRT. However, no significant effects of IGRT on acute rectal toxicity, late GU toxicity, 5-year OS and SCM were found.
For men receiving prostate radiotherapy, IGRT was associated with an improvement in biochemical tumor control and a reduction in GI and acute GU toxicity, but did not significantly improve 5-year OS or increase 5-year SCM.
图像引导放射治疗（IGRT）已逐渐在临床实践中广泛推广。然而，关于IGRT对毒性和生存率的影响尚未达成共识，甚至尚未发布明确的一级证据。
检索了Medline、EMBASE、PubMed、Cochrane数据库和ClinicalTrials.gov，以查找在前列腺放疗期间比较IGRT与非IGRT或高频IGRT与低频IGRT的研究，检索时间从数据库建立至2022年4月。
该综述纳入了18项研究（3项随机临床试验和15项队列研究），涉及6521名男性，IGRT组患者的中位随访时间为46.2个月，而对照组为52.7个月。分析表明，与非IGRT相比，IGRT显著降低了急性泌尿生殖系统毒性（风险比[RR]，0.78；95%置信区间[CI]，0.69 - 0.88；P < 0.001[9项研究]）和胃肠道毒性（RR，0.49；95% CI，0.35 - 0.68；P < 0.001[4项研究]）以及晚期胃肠道毒性（风险比[HR]，0.25；95% CI，0.07 - 0.87；P = 0.03[3项研究]）。同时，与前瞻性研究相比，回顾性研究表明IGRT在降低晚期胃肠道毒性方面效果更显著。与非每日IGRT相比，每日IGRT显著改善了3年无进展生存率（HR，0.45；95% CI，0.28 - 0.72；P = 0.001[2项研究]）和无远处转移生存率（HR，0.57；95% CI，0.39 - 0.83；P = 0.003[3项研究]）。此外，高频每日IGRT在前列腺癌患者中比每周IGRT能带来更大的3年无远处转移生存率获益。然而，未发现IGRT对急性直肠毒性、晚期泌尿生殖系统毒性、5年总生存率和无远处转移生存率有显著影响。
对于接受前列腺放疗的男性，IGRT与生化肿瘤控制的改善以及胃肠道和急性泌尿生殖系统毒性的降低相关，但未显著改善5年总生存率或提高5年无远处转移生存率。
