Efficacy and safety of high-dose versus conventional-dose conventionally fractionated external beam radiotherapy for stage T1b-4N0-1M0 prostate cancer:a meta-analysis
Wang Hui1,4, Xie Ruilin1,4, Qin Qingwei1,4, Li Na1,4, Wang Sheng1,4, Zhao Xue1,4, Qin Zhaohui2, Yao Yuanhu1,3
1Department of Radiation OncoloGy,The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China; 2School of Public Health,Xuzhou Medical University,Xuzhou 221004,China; 3School of Medical Imaging,Xuzhou Medical University,Xuzhou 221004,China; 4Graduate school of Xuzhou Medical University,Xuzhou 221004,China
Abstract：Objective To systematically evaluate the clinical efficacy and safety between high-dose (74 to 80 Gy) and conventional-dose (64.0 to 70.2 Gy) conventionally fractionated external beam radiotherapy for stage T1b-4N0-1M0 prostate cancer in this meta-analysis. Methods A literature search was performed in PubMed,Embase,Cochrane Library,Web of Science,CBM,Wanfang Data,CNKI and Chongqing VIP to collect clinical trials on high-dose versus conventional-dose conventionally fractionated external beam radiotherapy of prostate cancer from the inception to July 1, 2018. The included literatures were evaluated by Cochrane quality evaluation criteria and subject to meta-analysis by using Review Manager 5.3 statistical software. Results A total of 7 randomized controlled clinical trials involving 4 132 patients were included in the meta-analysis. The meta-analysis showed that the high-dose and conventional-dose groups yielded similar 10-year overall survival (RR=1.01,95%CI:0.96 to 1.07,P=0.64) and 10-year prostate cancer-specific survival (RR=1.01,95%CI:0.98 to 1.03,P=0.47). The biochemical failure rate in the high-dose group was significantly lower than that in the conventional-dose group (RR=0.78,95%CI:0.70 to 0.86,P<0.01). Compared with the conventional-dose group,the incidence of late grade ≥2 gastrointestinal and genitourinary adverse reactions (RR=1.48,95%CI:1.31 to 1.67,P<0.01;RR=1.35,95%CI:1.06 to 1.73,P=0.02) was significantly higher in the high-dose group. Conclusion High-dose conventionally fractionated external beam radiotherapy has advantages in reducing the biochemical failure rate of patients with stage T1b-4N0-1M0 prostate cancer. Nevertheless, whether it can improve overall survival and prostate cancer-specific survival remains to be validated. High-dose radiotherapy also induce a higher incidence rate of late grade ≥2 gastrointestinal and genitourinary adverse reactions compared with conventional-dose radiotherapy.
Wang Hui,Xie Ruilin,Qin Qingwei et al. Efficacy and safety of high-dose versus conventional-dose conventionally fractionated external beam radiotherapy for stage T1b-4N0-1M0 prostate cancer:a meta-analysis[J]. Chinese Journal of Radiation Oncology, 2019, 28(7): 514-517.
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