Efficacy and adverse effects of hypofractionated radiotherapy versus conventionally fractionated radiotherapy in patients with intermediate-to high-risk localized prostate cancer:a meta-analysis
Abstract：Objective To compare the efficacy and adverse effects of hypofractionated radiotherapy versus conventionally fractionated radiotherapy for intermediate-to high-risk localized prostate cancer .Methods A literature search was performed in PubMed, Embase, Web of Science, CNKI, VIP database, and Wanfang Data to collect the controlled clinical trials of hypofractionated radiotherapy versus conventionally fractionated radiotherapy in patients with intermediate-to high-risk localized PCa published up to August 31, 2016. Stata 12.0 was used for meta-analysis. The difference between two groups was estimatedby calculating the hazard ratio (HR) or risk ratio (RR) with 95% confidence interval (CI). Results According to the inclusion and exclusion criteria, a total of 5 controlled clinical trials involving 1621 patients with PCa were included in this meta-analysis. The meta-analysis showed that overall survival (HR=1.00, 95%CI:0.85-1.17, P=0.980) and biochemical failure (RR=0.87, 95%CI:0.68-1.12, P=0.274) were comparable between the two groups. Compared with the conventionally fractionated radiotherapy, the incidence of acute gastrointestinal adverse events (grade≥2) was significantly higher in the hypofractionated radiotherapy (RR=1.94, 95%CI:1.23-3.06, P=0.004). However, there were no significant differences in the incidence of acute genitourinary adverse events (grade≥2)(RR=1.03, 95%CI:0.92-1.14,P=0.626), late gastrointestinal adverse events (grade≥2)(RR=1.17,95%CI:0.90-1.51, P=0.238), and late genitourinary adverse events (grade≥2)(RR=1.11, 95%CI:0.94-1.30, P=0.228) between the two groups. Conclusions Conventionally fractionated radiotherapy and hypofractionated radiotherapy have comparable therapeutic effects in patients with intermediate-to high-risk localized PCa. Although the patients treated with hypofractionated radiotherapy have a higher incidence of acute gastrointestinal adverse events than those treated with conventionally fractionated radiotherapy, the incidence of late gastrointestinal and genitourinary adverse events is comparable between the two groups of patients and the adverse effects are tolerable.
Guo Wei,Gu Xiaobin,Qi Xin et al. Efficacy and adverse effects of hypofractionated radiotherapy versus conventionally fractionated radiotherapy in patients with intermediate-to high-risk localized prostate cancer:a meta-analysis[J]. Chinese Journal of Radiation Oncology, 2017, 26(5): 542-545.
[1] Chen W,Zheng R,Baade PD,et al. Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.DOI:10.3322/caac.21338. [2] Chan SY,Ng CF,Lee KW,et al. Differences in cancer characteristics of Chinese patients with prostate cancer who present with different symptoms[J].Hong Kong Med J,2016.DOI:10.12809/hkmj164875. [3] Peyromaure M,Debre B,Mao K,et al. Management of prostate cancer in China:a multicenter report of 6 institutions[J].J Urol,2005,174(5):1794-1797.DOI:10.1097/01.ju.0000176817.46279.93. [4] Miralbell R,Roberts S A,Zubizarreta E,et al. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets:alpha/beta= 1.4(0.9-2.2) Gy[J].Int J Radiat Oncol Biol Phys,2012,82(1):e17-e24.DOI:10.1016/j.ijrobp.2010.10.075. [5] Aluwini S,Pos F,Schimmel E,et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO):acute toxicity results from a randomised non-inferiority phase 3 trial[J].Lancet Oncol,2015,16(3):274-283.DOI:10.1016/S1470-2045(14)70482-6. [6] Aluwini S,Pos F,Schimmel E,et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO):late toxicity results from a randomised,non-inferiority,phase 3 trial[J].Lancet Oncol,2016,17(4):464-474.DOI:10.1016/S1470-2045(15)00567-7. [7] Incrocci L,Wortel R C,Alemayehu W G,et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO):final efficacy results from a randomised,multicentre,open-label,phase 3 trial[J].Lancet Oncol,2016,17(8):1061-1069.DOI:10.1016/S1470-2045(16)30070-5. [8] Arcangeli G,Saracino B,Gomellini S,et al. A prospective phase Ⅲ randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer[J].Int J Radiat Oncol Biol Phys,2010,78(1):11-18.DOI:10.1016/j.ijrobp.2009.07.1691. [9] Arcangeli G,Fowler J,Gomellini S,et al. Acute and late toxicity in a randomized trial of conventional versus hypofractionated three-dimensional conformal radiotherapy for prostate cancer[J].Int J Radiat Oncol Biol Phys,2011,79(4):1013-1021.DOI:10.1016/j.ijrobp.2009.12.045. [10] Arcangeli S,Strigari L,Gomellini S,et al. Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer[J].Int J Radiat Oncol Biol Phys,2012,84(5):1172-1178.DOI:10.1016/j.ijrobp.2012.02.049. [11] Pollack A,Hanlon AL,Horwitz EM,et al. Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial[J].Int J Radiat Oncol Biol Phys,2006,64(2):518-526.DOI:10.1016/j.ijrobp.2005.07.970. [12] Pollack A,Walker G,Horwitz E M,et al. Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer[J].J Clin Oncol,2013,31(31):3860-3868.DOI:10.1200/JCO.2013.51.1972. [13] Marzi S,Saracino B,Petrongari M G,et al. Modeling of alpha/beta for late rectal toxicity from a randomized phase Ⅱ study:conventional versus hypofractionated scheme for localized prostate cancer[J].J Exp Clin Cancer Res,2009,28:117.DOI:10.1186/1756-9966-28-117. [14] Strigari L,Arcangeli G,Arcangeli S,et al. Mathematical model for evaluating incidence of acute rectal toxicity during conventional or hypofractionated radiotherapy courses for prostate cancer[J].Int J Radiat Oncol Biol Phys,2009,73(5):1454-1460.DOI:10.1016/j.ijrobp.2008.07.024. [15] Dearnaley DP,Jovic G,Syndikus I,et al. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer:long-term results from the MRC RT01 randomised controlled trial[J].Lancet Oncol,2014,15(4):464-473.DOI:10.1016/S1470-2045(14)70040-3. [16] Denham JW,Steigler A,Joseph D,et al. Radiation dose escalation or longer androgen suppression for locally advanced prostate cancer? Data from the TROG 03.04 RADAR trial[J].Radiother Oncol,2015,115(3):301-307.DOI:10.1016/j.radonc.2015.05.016. [17] Kuban DA,Tucker SL,Dong L,et al. Long-term results of the M.D.Anderson randomized dose-escalation trial for prostate cancer[J].Int J Radiat Oncol Biol Phys,2008,70(1):67-74.DOI:10.1016/j.ijrobp.2007.06.054. [18] Kalbasi A,Li J,Berman A,et al. Dose-Escalated Irradiation and Overall Survival in Men With Nonmetastatic Prostate Cancer[J].JAMA Oncol,2015,1(7):897-906.DOI:10.1001/jamaoncol.2015.2316. [19] Aneja S,Pratiwadi R R,Yu J B.Hypofractionated radiation therapy for prostate cancer:risks and potential benefits in a fiscally conservative health care system[J].Oncology (Williston Park),2012,26(6):512-518. [20] Botrel TE,Clark O,Pompeo AC,et al. Hypofractionated external-beam radiation therapy (HEBRT) versus conventional external-beam radiation (CEBRT) in patients with localized prostate cancer:a systematic review and meta-analysis[J].Core Evid,2013,8:1-13.DOI:10.2147/CE.S41178. [21] Hoffman KE,Voong KR,Pugh TJ,et al. Risk of late toxicity in men receiving dose-escalated hypofractionated intensity modulated prostate radiation therapy:results from a randomized trial[J].Int J Radiat Oncol Biol Phys,2014,88(5):1074-1084.DOI:10.1016/j.ijrobp.2014.01.015. [22] Cao L,Yang YJ,Li Z W,et al. Moderate hypofractionated radiotherapy is more effective and safe for localized prostate cancer patients:a meta-analysis[J].Oncotarget,2016.DOI:10.18632/oncotarget.13735. [23] Martin J M,Rosewall T,Bayley A,et al. Phase Ⅱ trial of hypofractionated image-guided intensitymodulated radiotherapy for localized prostate adenocarcinoma[J].Int J Radiat Oncol Biol Phys,2007,69(4):1084-1089.DOI:10.1016/j.ijrobp.2007.04.049. [24] Kupelian PA,Thakkar VV,Khuntia D,et al. Hypofractionated intensity-modulated radiotherapy (70 gy at 2.5 Gy per fraction) for localized prostate cancer:long-term outcomes[J].Int J Radiat Oncol Biol Phys,2005,63(5):1463-1468.DOI:10.1016/j.ijrobp.2005.05.054.
2017, Vol. 26 
