结节性寡复发前列腺癌的挽救性立体定向放射治疗：随机对照试验的系统回顾和元分析》。

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-10-23 DOI:10.1016/j.clgc.2024.102239

Ayesha Aman , Arfa Akram , Bisma Akram , Ali Husnain , Aleena Akram , Sania Akram , Eeman Ahmad , Arsalan Nadeem

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引用次数: 0

摘要

背景：前列腺癌的复发率很高，复发通常与主要扩散到较少盆腔或盆腔外淋巴结的结节复发模式有关。这项荟萃分析旨在确定对少复发结节型前列腺癌患者进行挽救性体位立体定向放射治疗（SBRT）的安全性和生存结果：我们检索了Cochrane对照试验中央登记册、PubMed、ClinicalTrials.gov和Google Scholar，检索了从开始到2024年5月的所有相关随机对照试验（RCT）。使用风险比（RR）和95%置信区间（CI）对二分法结果进行汇总，使用危险比（HR）和95%置信区间（CI）报告生存结果：结果：共纳入了三项研究，312 名患者（中位年龄大于 18-79 岁）。在312名患者中，135人接受了SBRT和药物治疗，122人接受了观察、药物治疗或选择性结节放疗。SBRT能明显提高无生化复发生存率（HR：0.45；95% CI，0.28-0.73），研究间异质性极小（I2 = 0%）。SBRT不影响2级泌尿生殖系统（GU）毒性水平（不良事件通用术语标准[CTCAE] v4.0）（RR：0.74；95% CI，0.32-1.70；（I2 = 0%）），也不影响2级胃肠道（GI）毒性水平（CTCAE v4.0）（RR：1.05；95% CI，0.26-4.31；I2 = 0%）。SBRT与1级毒性水平（CTCAE v4.0）的任何显著变化无关（RR：1.08；95% CI：0.62-1.89），具有中度异质性（I2 = 63%）：SBRT可提高少复发前列腺癌患者的无生化复发生存率，但不会增加1级和2级GU/GI毒性水平。

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Salvage Stereotactic Radiotherapy for Nodal Oligo-Recurrent Prostate Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Prostate cancer has a high frequency of relapse, and the relapse is usually associated with a nodal recurrence pattern spreading predominantly to fewer pelvic or extra-pelvic lymph nodes. This meta-analysis sought to determine the safety and survival outcomes of salvage body stereotactic radiotherapy (SBRT) in oligo-recurrent nodal prostate cancer patients.

Methods

We searched the Cochrane Central Register of Controlled Trials, PubMed, ClinicalTrials.gov, and Google Scholar to retrieve all the relevant randomized controlled trials (RCTs) from inception to May 2024. Dichotomous outcomes were pooled using risk ratios (RR) with a 95% confidence interval (CI), whereas survival outcomes were reported using hazard ratios (HR) with a 95% CI.

Results

Three RCTs with a total of 312 patients (median age range of >18-79) were included. Of 312 patients, 135 received SBRT with medical therapy, while 122 underwent either observation, medical therapy, or elective nodal radiotherapy. SBRT significantly increased the biochemical recurrence-free survival (HR: 0.45; 95% CI, 0.28-0.73) with minimal inter-study heterogeneity (I2 = 0%). SBRT did not affect the grade 2 genitourinary (GU) toxicity levels (Common Terminology Criteria for Adverse Events [CTCAE] v4.0) (RR: 0.74; 95% CI, 0.32-1.70; (I2 = 0%) nor the grade 2 gastrointestinal (GI) toxicity levels (CTCAE v4.0) (RR: 1.05; 95% CI, 0.26-4.31; I2 = 0%). SBRT was not associated with any significant change in the grade 1 toxicity levels (CTCAE v4.0) (RR, 1.08; 95% CI, 0.62-1.89) with moderate heterogeneity (I2 = 63%).

Conclusion

SBRT improves biochemical recurrence-free survival in patients with oligo-recurrent prostate cancer without increasing grade 1 and grade 2 GU/GI toxicity levels.

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.