Conventional versus hypofractionated radiotherapy in localized or locally advanced prostate cancer: A systematic review and meta-analysis along with therapeutic implications

Publication date: Available online 22 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Niloy R. Datta, Emanuel Stutz, Susanne Rogers, Stephan Bodis
PurposeA systematic review and meta-analysis was conducted to evaluate the therapeutic outcomes of conventional (CRT) and hypofractionated radiotherapy (HRT) in localized or locally advanced prostate cancers (LLPCa).Material and methods599 abstracts were extracted from five databases and screened as per the PRISMA guidelines. Only phase III trials randomized between CRT and HRT in LLPCa with a minimum of 5-year follow-up were considered. The evaluated endpoints were - biochemical failure (BF), biochemical and/or clinical failure (BCF), overall mortality (OM), prostate cancer-specific mortality (PCaSM), both acute and late gastrointestinal (GI) and genitourinary (GU) (grade >2) toxicities.ResultsTen trials from nine publications, totaling 8,146 patients (CRT: 3,520; HRT: 4,626; one study compared two HRT schedules with a common CRT regime) were included in the evaluation. There were no significant differences in patient characteristics between the two arms. However, the radiotherapy treatment parameters differed significantly between CRT and HRT (all p<0.001). Use of androgen deprivation therapy (ADT) varied from 0-100% in both groups, (mean + SD: 43.3% + 43.6; CRT vs. HRT: p:ns). The odds ratio (OR), risk ratio (RR) and risk difference (RD) between CRT and HRT for BF, BCF, OM, PCaSM, acute GU, late GU and GI toxicities were all nonsignificant. Nevertheless, acute GI toxicities were 9.1% less with CRT (RD=0.091, OR=1.687, RR=1.470, all p<0.001). On subgroup analysis, patient groups with < vs.>66.8% ADT (RD: 0.052 vs. 0.136; p=0.008) and < vs.>76% full seminal vesicles in clinical target volume (RD: 0.034 vs. 0.108; p<0.001) were found to significantly influence the acute GI toxicity with HRT.ConclusionsHRT provides similar therapeutic outcomes to CRT in LLPCa except for a significantly higher risk of acute GI toxicity. HRT enables a reduction in overall treatment time and offers patient convenience. However variables contributing to an increased acute GI toxicity need careful consideration.



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