Abstract：Objective To conduct a meta-analysis to analyze the efficacy and adverse reactions of fractionated high dose rate brachytherapy (HDR-BT) as monotherapy for localized prostate cancer. Methods Relevant databases were searched to collect the clinical trials on HDR-BT as monotherapy in patients with localized prostate cancer. Included studies were limited to full-text publications of fractionated HDR-BT as monotherapy with a median follow-up of at least 5 years, and adequate reporting of treatment outcomes and adverse reactions data. Stata 12.0 was used for data analysis. Results According to the inclusion and exclusion criteria, a total of 11 clinical trials involving 2 683 patients with prostate cancer were included in this meta-analysis. The results of the meta-analysis showed that 5-year biochemical recurrence-free survival (bRFS) rate and overall survival (OS) rate were 94% (95%CI: 93% - 96%) and 96% (95%CI: 94% - 98%), respectively. Long-term (≥5 years) cancer-specific survival (CSS) rate and distant metastasis-free survival (DMFS) rate were 99% (95%CI: 98% - 100%) and 98% (95%CI: 98% - 99%), respectively. Long-term (≥5 years) late grade ≥3 grade gastrointestinal and genitourinary adverse reactions rates were 2% (95%CI: 1% - 3%) and 9% (95%CI: 6% - 13%), respectively. Conclusions Fractionated HDR-BT as monotherapy is an effective treatment for patients with localized prostate cancer. Its long-term efficacy is encouraging, and the treatment is well tolerated and safe.
Guo Wei,Sun Yunchuan,Lu Hongling et al. Meta-analysis of the efficacy and adverse reactions of fractionated high dose rate brachytherapy as monotherapy for localized prostate cancer[J]. Chinese Journal of Radiation Oncology, 2023, 32(7): 599-605.
[1] 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. [2] Blasko JC, Grimm PD, Ragde H. Brachytherapy and organ preservation in the management of carcinoma of the prostate[J]. Semin Radiat Oncol, 1993,3(4):240-249. DOI: 10.1053/SRAO00300240. [3] Mate TP, Gottesman JE, Hatton J, et al. High dose-rate afterloading 192Iridium prostate brachytherapy: feasibility report[J]. Int J Radiat Oncol Biol Phys, 1998,41(3):525-533. DOI: 10.1016/s0360-3016(98)00097-2. [4] Barnes J, Kennedy WR, Fischer-Valuck BW, et al. Treatment patterns of high-dose-rate and low-dose-rate brachytherapy as monotherapy for prostate cancer[J]. J Contemp Brachytherapy, 2019,11(4):320-328. DOI: 10.5114/jcb.2019.86974. [5] Hathout L, Mahmoud O, Wang YQ, et al. A phase II randomized pilot study comparing high-dose rate brachytherapy and low-dose rate brachytherapy as monotherapy in localized prostate cancer[J]. Adv Radiat Oncol, 2019,4(4):631-636. DOI: 10.1016/j.adro.2019. 04.003. [6] Martinez AA, Gonzalez J, Ye H, et al. Dose escalation improves cancer-related events at 10 years for intermediate- and high-risk prostate cancer patients treated with hypofractionated high-dose-rate boost and external beam radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2011,79(2):363-370. DOI: 10.1016/j.ijrobp.2009. 10.035. [7] 郭威, 孙云川. 高剂量率近距离治疗前列腺癌进展[J].中华放射肿瘤学杂志,2022,31(5):478-482. DOI: 10.3760/cma.j.cn113030-20200710-00354. Guo W, Sun YC. Research progress on high-dose-rate brachytherapy of localized prostate cancer[J].Chin J Radiat Oncol,2022,31(5):478-482. DOI: 10.3760/cma.j.cn113030-20200710-00354. [8] Morton G, McGuffin M, Chung HT, et al. Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy[J]. Radiother Oncol, 2020,146:90-96. DOI: 10.1016/j.radonc.2020.02.009. [9] Zamboglou N, Tselis N, Baltas D, et al. High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results[J]. Int J Radiat Oncol Biol Phys, 2013,85(3):672-678. DOI: 10.1016/j.ijrobp.2012.07.004. [10] Tselis N, Tunn UW, Chatzikonstantinou G, et al.High dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients[J]. Radiat Oncol, 2013,8:115. DOI: 10.1186/1748-717X-8-115. [11] Hauswald H, Kamrava MR, Fallon JM, et al. High-dose-rate monotherapy for localized prostate cancer: 10-year results[J]. Int J Radiat Oncol Biol Phys, 2016,94(4):667-674. DOI: 10.1016/j.ijrobp.2015.07.2290. [12] Jawad MS, Dilworth JT, Gustafson GS, et al. Outcomes associated with 3 treatment schedules of high-dose-rate brachytherapy monotherapy for favorable-risk prostate cancer[J]. Int J Radiat Oncol Biol Phys, 2016,94(4):657-666. DOI: 10.1016/j.ijrobp.2015.10.011. [13] Patel S, Demanes DJ, Ragab O, et al. High-dose-rate brachytherapy monotherapy without androgen deprivation therapy for intermediate-risk prostate cancer[J]. Brachytherapy, 2017,16(2):299-305. DOI: 10.1016/j.brachy.2016.11.002. [14] Hoskin P, Rojas A, Ostler P, et al. Single-dose high-dose-rate brachytherapy compared to two and three fractions for locally advanced prostate cancer[J]. Radiother Oncol, 2017,124(1):56-60. DOI: 10.1016/j.radonc.2017.06.014. [15] Yamazaki H, Masui K, Suzuki G, et al. Comparison of three moderate fractionated schedules employed in high-dose-rate brachytherapy monotherapy for clinically localized prostate cancer[J]. Radiother Oncol, 2018,129(2):370-376. DOI: 10.1016/j.radonc.2018.07.026. [16] Soatti CP, Delishaj D, D'Amico R, et al. High-dose-rate brachytherapy as monotherapy for localized prostate cancer using three different doses - 14 years of single-centre experience[J]. J Contemp Brachytherapy, 2020,12(6):533-539. DOI: 10.5114/jcb.2020.101685. [17] Johansson B, Olsén JS, Karlsson L, et al. High-dose-rate brachytherapy as monotherapy for low- and intermediate-risk prostate cancer: long-term experience of Swedish single-center[J]. J Contemp Brachytherapy, 2021,13(3):245-253. DOI: 10.5114/jcb.2021.105846. [18] Behmueller M, Tselis N, Zamboglou N, et al.High-dose-rate brachytherapy as monotherapy for low- and intermediate-risk prostate cancer. Oncological outcomes after a median 15-year follow-up[J]. Front Oncol, 2021,11:770959. DOI: 10.3389/fonc.2021.770959. [19] Miñana B, Rodríguez-Antolín A, Gómez-Veiga F, et al. Treatment trends for clinically localised prostate cancer. National population analysis: GESCAP group[J]. Actas Urol Esp, 2016,40(4):209-216. DOI: 10.1016/j.acuro. 2015.09.005. [20] Frank SJ, Pugh TJ, Blanchard P, et al. Prospective phase 2 trial of permanent seed implantation prostate brachytherapy for intermediate-risk localized prostate cancer: efficacy, toxicity,quality of life outcomes[J]. Int J Radiat Oncol Biol Phys, 2018,100(2):374-382. DOI: 10.1016/j.ijrobp.2017.09.050. [21] Jackson WC, Silva J, Hartman HE, et al. Stereotactic body radiation therapy for localized prostate cancer: a systematic review and meta-analysis of over 6,000 patients treated on prospective studies[J]. Int J Radiat Oncol Biol Phys, 2019,104(4):778-789. DOI: 10.1016/j.ijrobp.2019.03.051. [22] Dearnaley D, Syndikus I, Mossop H, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial[J]. Lancet Oncol, 2016,17(8):1047-1060. DOI: 10.1016/S1470-2045(16)30102-4. [23] Vigneault E, Mbodji K, Magnan S, et al. High-dose-rate brachytherapy boost for prostate cancer treatment: different combinations of hypofractionated regimens and clinical outcomes[J]. Radiother Oncol, 2017,124(1):49-55. DOI: 10.1016/j.radonc.2017.06.012. [24] Martinez AA, Gustafson G, Gonzalez J, et al. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer[J]. Int J Radiat Oncol Biol Phys, 2002,53(2):316-327. DOI: 10.1016/s0360-3016(02)02733-5. [25] Kukiełka AM, Dąbrowski T, Walasek T, et al. High-dose-rate brachytherapy as a monotherapy for prostate cancer--single-institution results of the extreme fractionation regimen[J]. Brachytherapy, 2015,14(3):359-365. DOI: 10.1016/j.brachy.2015.01.004. [26] Yoshioka Y, Suzuki O, Otani Y, et al. High-dose-rate brachytherapy as monotherapy for prostate cancer: technique, rationale and perspective[J]. J Contemp Brachytherapy, 2014,6(1):91-98. DOI: 10.5114/jcb.2014. 42026. [27] Demanes DJ, Ghilezan MI. High-dose-rate brachytherapy as monotherapy for prostate cancer[J]. Brachytherapy, 2014,13(6):529-541. DOI: 10.1016/j.brachy.2014.03.002. [28] Radiation Therapy Oncology Group. Radiation therapy with or without androgen-deprivation therapy in treating patients with prostate cancer[EB/OL].(2009-06-10)[2022-09-10]. https://clinicaltrials.gov/ct2/show/NCT00936390. [29] Zumsteg ZS, Spratt DE, Pei X, et al. Short-term androgen-deprivation therapy improves prostate cancer-specific mortality in intermediate-risk prostate cancer patients undergoing dose-escalated external beam radiation therapy[J]. Int J Radiat Oncol Biol Phys, 2013,85(4):1012-1017. DOI: 10.1016/j.ijrobp.2012.07.2374. [30] Denham JW, Joseph D, Lamb DS, et al. Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): 10-year results from a randomised, phase 3, factorial trial[J]. Lancet Oncol, 2019,20(2):267-281. DOI: 10.1016/S1470-2045(18)30757-5. [31] Rodda S, Tyldesley S, Morris WJ, et al. ASCENDE-RT: an analysis of treatment-related morbidity for a randomized trial comparing a low-dose-rate brachytherapy boost with a dose-escalated external beam boost for high- and intermediate-risk prostate cancer[J]. Int J Radiat Oncol Biol Phys, 2017,98(2):286-295. DOI: 10.1016/j.ijrobp. 2017.01.008. [32] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) andthe European Organization for Research and Treatment of Cancer (EORTC)[J]. Int J Radiat Oncol Biol Phys, 1995,31(5):1341-1346. DOI: 10.1016/0360-3016(95)00060-C. [33] Ghadjar P, Oesch SL, Rentsch CA, et al.Late toxicity and five year outcomes after high-dose-rate brachytherapy as a monotherapy for localized prostate cancer[J]. Radiat Oncol, 2014,9:122. DOI: 10.1186/1748-717X-9-122. [34] Yaxley JW, Lah K, Yaxley JP, et al. Long-term outcomes of high-dose-rate brachytherapy for intermediate- and high-risk prostate cancer with a median follow-up of 10 years[J]. BJU Int, 2017,120(1):56-60. DOI: 10.1111/bju. 13659.
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