Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, Medical Center - Uwniversity of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Oncology Center, European University Cyprus, Limassol, Cyprus.
Int J Radiat Oncol Biol Phys. 2024 Mar 15;118(4):998-1010. doi: 10.1016/j.ijrobp.2023.09.053. Epub 2023 Oct 19.
This systematic review and meta-analysis aimed to evaluate the evidence for ultrahypofractionated pelvic nodal irradiation in patients with prostate cancer, with a focus on reported acute and late toxicities.
A comprehensive search was conducted in 5 electronic databases (PubMed, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov) from inception until March 23, 2023. Eligible publications included patients with intermediate- and high-risk and node-positive prostate cancer who underwent elective or therapeutic ultrahypofractionated pelvic nodal irradiation. Primary outcomes included the presence of grade ≥2 rates of acute and late gastrointestinal and genitourinary toxicity based on the Common Terminology Criteria for Adverse Events or Radiation Therapy Oncology Group scales. Quality assessment was performed using National Institutes of Health tools for noncontrolled beforeand after (single arm) clinical trials, as well as single-arm observational studies. Because all outcomes were categorical variables, proportion was calculated to estimate the effect size and compare the outcomes after the intervention.
We identified 16 publications that reported the use of ultrahypofractionated radiation therapy to treat the pelvis in prostate cancer. Seven publications met our criteria and were included in the meta-analysis, including 417 patients. The median total dose to the pelvic lymph nodes was 25 Gy (range, 25-28.5 Gy), with a median of 5 fractions. The prostate received a median dose of 40 Gy (range, 35-47.5 Gy). All studies used androgen deprivation therapy for a median duration of 18 months. The median follow-up period was 3 years (range, 0.5-5.6 years). The rates of acute grade ≥2 gastrointestinal and genitourinary toxicity were 8% (95% CI, 1%-15%) and 29% (95% CI, 18%-41%), respectively. For late grade ≥2 gastrointestinal and genitourinary toxicity, the rates were 13% (95% CI, 5%-21%) and 29% (95% CI, 17%-42%), respectively.
Ultrahypofractionated pelvic nodal irradiation appears to be a safe approach in terms of acute and late genitourinary and gastrointestinal toxicity.
本系统评价和荟萃分析旨在评估前列腺癌患者接受超分割盆腔淋巴结照射的证据，重点关注报告的急性和晚期毒性。
从创建到 2023 年 3 月 23 日，我们在 5 个电子数据库（PubMed、Scopus、Web of Science、Cochrane Library、ClinicalTrials.gov）中进行了全面搜索。合格的出版物包括接受选择性或治疗性超分割盆腔淋巴结照射的中高危和淋巴结阳性前列腺癌患者。主要结局包括根据常见不良事件术语标准或放射治疗肿瘤学组量表报告的急性和晚期胃肠道和泌尿生殖系统毒性≥2 级的发生率。使用美国国立卫生研究院的工具对非对照的前后（单臂）临床试验以及单臂观察性研究进行质量评估。由于所有结局都是分类变量，因此计算了比例以估计效应大小并比较干预后的结局。
我们确定了 16 篇报道使用超分割放射治疗治疗前列腺癌盆腔的出版物。有 7 篇符合我们的标准并纳入荟萃分析，包括 417 名患者。盆腔淋巴结的中位总剂量为 25 Gy（范围，25-28.5 Gy），中位分割次数为 5 次。前列腺接受中位剂量 40 Gy（范围，35-47.5 Gy）。所有研究均使用雄激素剥夺治疗，中位持续时间为 18 个月。中位随访时间为 3 年（范围，0.5-5.6 年）。急性≥2 级胃肠道和泌尿生殖系统毒性的发生率分别为 8%（95%CI，1%-15%）和 29%（95%CI，18%-41%）。晚期≥2 级胃肠道和泌尿生殖系统毒性的发生率分别为 13%（95%CI，5%-21%）和 29%（95%CI，17%-42%）。
就急性和晚期泌尿生殖系统和胃肠道毒性而言，超分割盆腔淋巴结照射似乎是一种安全的方法。
