Local salvage therapies in patients with radio-recurrent prostate cancer following external beam radiotherapy: a systematic review and meta-analysis.

IF 5.1 2区医学 Q1 ONCOLOGY

Prostate Cancer and Prostatic Diseases Pub Date : 2024-09-02 DOI:10.1038/s41391-024-00883-3

Massimiliano Creta, Shahrokh F Shariat, Giancarlo Marra, Paolo Gontero, Marta Rossanese, Simone Morra, Jeremy Teoh, Amar U Kishan, R Jeffrey Karnes, Nicola Longo

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Abstract

Introduction: To date, radio-recurrent prostate cancer (PCa) ranks as the fourth most common urological malignancy when considering the number of men with localized PCa who undergo radiation treatment and subsequently experience a biochemical recurrence. This systematic review aimed to summarize available evidence about the outcomes of local salvage strategies in patients with local PCa recurrence following primary external-beam radiation therapy (EBRT).

Methods: We conducted a comprehensive bibliographic search on MEDLINE, Scopus, and Web of Science Core Collection databases in October 2023 to identify studies published in the last 20 years evaluating outcomes of local salvage procedures in patients with locally radio-recurrent PCa following EBRT. The meta-analysis was performed using ProMeta 3 software when two or more studies reported the same outcome. The effect size (ES) was estimated using rates reported with its 95% confidence interval (CI).

Results: Overall, 28 studies (6 prospective and 22 retrospective) including 1544 patients were included in the review. Two-year recurrence-free survival (RFS) was 84.0% (95% CI: 67.0-93.0%), 69.0% (95% CI: 42.0-87.0%), 58.0% (95% CI: 43.0-71.0%), and 45% (95% CI: 38.0-52.0%), for patients undergoing brachytherapy (BT), EBRT, Cryotherapy and High-Intensity Focused Ultrasound (HIFU), respectively. After salvage prostatectomy, RFS ranged from 75% to 78.5% at a median follow-up ranging from 18 to 35 months. Estimates for severe gastrointestinal toxicity were 2%, 3%, 3%, 4%, and 11% following cryotherapy, BT, HIFU, EBRT, and salvage radical prostatectomy, respectively.

Conclusions: In patients who underwent EBRT as primary treatment, prostate salvage re-irradiation through BT or EBRT represents the modality providing the best balance between efficacy and safety. Unfortunately, due to the low level of evidence, strong recommendations regarding the choice of any of these techniques cannot be made.

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外照射放疗后放射复发前列腺癌患者的局部挽救疗法：系统综述和荟萃分析。

导言：迄今为止，考虑到接受放射治疗后出现生化复发的局部 PCa 男性患者人数，放射复发前列腺癌（PCa）已成为第四大最常见的泌尿系统恶性肿瘤。本系统性综述旨在总结有关原发性体外放射治疗（EBRT）后局部PCa复发患者局部挽救策略结果的现有证据：我们于 2023 年 10 月在 MEDLINE、Scopus 和 Web of Science Core Collection 数据库中进行了全面的文献检索，以确定过去 20 年中发表的评估 EBRT 后局部放射复发 PCa 患者局部挽救手术效果的研究。如果有两项或两项以上的研究报告了相同的结果，则使用 ProMeta 3 软件进行荟萃分析。使用报告的比率及其95%置信区间（CI）估算效应大小（ES）：总共有 28 项研究（6 项前瞻性研究和 22 项回顾性研究），包括 1544 名患者被纳入审查范围。接受近距离治疗（BT）、EBRT、冷冻治疗和高强度聚焦超声（HIFU）的患者两年无复发生存率（RFS）分别为84.0%（95% CI：67.0-93.0%）、69.0%（95% CI：42.0-87.0%）、58.0%（95% CI：43.0-71.0%）和45%（95% CI：38.0-52.0%）。挽救性前列腺切除术后，中位随访时间为18至35个月，RFS为75%至78.5%。冷冻疗法、BT、HIFU、EBRT和挽救性前列腺癌根治术的严重胃肠道毒性估计分别为2%、3%、3%、4%和11%：对于接受 EBRT 作为初治的患者，通过 BT 或 EBRT 进行前列腺挽救性再照射是疗效和安全性之间取得最佳平衡的方式。遗憾的是，由于证据水平较低，因此无法就选择其中任何一种技术提出有力的建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学

CiteScore

10.00

自引率

6.20%

发文量

142

审稿时长

6-12 weeks

期刊介绍： Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.