Roukoz Camille, Lazrek Amina, Bardoscia Lilia, Rubini Giuseppe, Liu Chieh-Min, Serre Anne-Agathe, Sardaro Angela, Rubini Dino, Houabes Sarah, Laude Cecile, Cozzi Salvatore
Radiation Oncology Department, Centre Leon Berard, 69373 Lyon, France.
Radiation Oncology Unit, International University Hospital Cheikh Zaid, Rabat 10000, Morocco.
Cancers (Basel). 2024 Dec 18;16(24):4227. doi: 10.3390/cancers16244227.
Radical prostatectomy (RP) is one possible curative treatment for localized prostate cancer. Despite that, up to 40% of patients will later relapse. Currently, post-operative radiotherapy (PORT) courses deliver 1.8-2 Gy daily to reach a total dose ranging between 64 and 74 Gy, completed in 7-8 weeks. Several articles reported encouraging data in terms of the effectiveness and the related toxicities using hypofractionation schedules. The objective of the present systematic review was to evaluate the clinical outcomes and toxicity of the use of hypofractionation in adjuvant/salvage prostate cancer treatments.
Medline was searched via PubMed and Scopus from inception to July 2024 to retrieve studies on hypofractionation in adjuvant/salvage prostate cancer treatments. This study was conducted under PRISMA guidelines.
A total of 139 articles were identified from the initial search. Subsequently, the 139 studies were reviewed by title and abstract. Ninety-five studies were excluded due to being either abstracts or articles not available in English. In the second step, the full texts of 44 studies were reviewed. Eleven studies were excluded for being reviews, study protocols, or focused on SBRT treatments. Finally, 33 studies were included in our analysis, with a total number of 4269 patients. Of the 33 selected studies, 20 were retrospective trials and 11 were phase I/II prospective trials, while 2 studies were prospective phase III trials. The follow-up ranged from 18 to 217 months. Failure-free survival, for those with the longer follow-up, ranged between 85% and 91% at 3 years, 47 and 78.6% at 5 years and 51.5% at 10 years. Genitourinary (GU) and gastrointestinal acute toxicity was mild to moderate with similar rates across the normofractionated and hypofractionated groups. Acute grade-3 GU toxicity events were unusual, occurring in less than 4% of the cases overall.
The present study is the first systematic review of the literature that includes the first two randomized phase III studies published in the literature. Hypofractionated treatment has been shown to be safe, effective, with moderate toxicity and not inferior to conventional RT, with good biochemical control rates.
根治性前列腺切除术（RP）是局限性前列腺癌的一种可能的治愈性治疗方法。尽管如此，高达40%的患者随后会复发。目前，术后放疗（PORT）疗程每天给予1.8 - 2 Gy，总剂量在64至74 Gy之间，在7 - 8周内完成。几篇文章报道了在使用大分割放疗方案方面，关于有效性和相关毒性的令人鼓舞的数据。本系统评价的目的是评估大分割放疗在辅助/挽救性前列腺癌治疗中的临床结局和毒性。
通过PubMed和Scopus对Medline从创刊至2024年7月进行检索，以获取关于大分割放疗在辅助/挽救性前列腺癌治疗中的研究。本研究按照PRISMA指南进行。
初始检索共识别出139篇文章。随后，对这139项研究进行了标题和摘要审查（筛选）。95项研究因是摘要或无英文版本而被排除。第二步，对44项研究的全文进行了审查。11项研究因是综述、研究方案或聚焦于立体定向体部放疗（SBRT）治疗而被排除。最终，33项研究纳入我们的分析，患者总数为4269例。在这33项入选研究中，20项为回顾性试验，11项为I/II期前瞻性试验，2项为前瞻性III期试验。随访时间为18至217个月。对于随访时间较长的患者，无失败生存率在3年时为85%至91%，5年时为47%至78.6%，10年时为51.5%。泌尿生殖系统（GU）和胃肠道急性毒性为轻至中度，常规分割和大分割组发生率相似。急性3级GU毒性事件不常见，总体发生率低于4%。
本研究是首次对文献进行的系统评价，纳入了文献中发表的前两项随机III期研究。大分割放疗已被证明是安全、有效的，毒性适中，且不劣于传统放疗，生化控制率良好。
