Critical reviews in oncology/hematology · 2026
The safety and effectiveness of hypofractionated radiotherapy for localized prostate cancer: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Mo Chunhao, Chen Chuanjian, Fan Lei, Li Jiawei, Fan Ning, Ding Hui
Аннотация
OBJECTIVE: To determine the differences in rates of acute and late toxic effects, overall survival (OS), failure-free survival (FFS), and biochemical failure-free survival (BFS) between patients receiving ultra-hypofractionated radiation therapy (UHRT) vs conventionally fractionated radiotherapy (CFRT), UHRT vs moderate hypofractionated radiation therapy (MHRT), or MHRT vs CFRT.
METHODS AND MATERIALS: Medline (PubMed), Embase,and Cochrane Database of Systematic Reviews were searched from inception through November 30, 2024. Randomized clinical trials or prospective/retrospective cohort studies comparing outcomes in patients with localized prostate cancer who received UHRT vs CFRT, UHRT vs MHRT, or MHRT vs CFRT. The main measurement outcomes included rates of acute and late GU (genitourinary) and GI (gastrointestinal) toxicity, OS, FFS, and BFS.
RESULTS: After reviewing 2938 reports, 41 unique studies including a total of 12,947 unique patients were selected. Regarding acute GI toxicity,MHRT showed a significantly higher incidence compared with CFRT (OR 1.37, 95%CI 1.10-1.71). Conversely, UHRT demonstrated a significantly lower risk compared with MHRT(OR 0.46, 95%CI 0.27-0.79). Notably, no statistically significant difference was observed between UHRT and CFRT. For other comparisons, there were no statistically significant differences in the proportion of acute GU toxicity across any comparison groups (MHRT vs CFRT, UHRT vs MHRT,or UHRT vs CFRT). Similarly,no significant differences were found in the prevalence of late GI or GU toxicity between MHRT and CFRT,or UHRT and MHRT. The pooled analysis suggested an improvement in 5-year FFS with MHRT compared with CFRT (HR 0.89, P = 0.04). However, sensitivity analysis indicated that this statistical finding was not robust and was largely driven by a single study. No statistically significant difference in 5-year OS was found between MHRT and CFRT. Similarly, no statistically significant differences in 5-year FFS and 5-year OS were observed between UHRT and CFRT. For UHRT vs MHRT, there were no significant differences in 3-year BFS and 3-year OS.
CONCLUSIONS: The findings suggest that UHRT is a promising strategy for localized prostate cancer. Regarding acute GI toxicity, both UHRT and CFRT demonstrated lower risks compared with MHRT. Regarding oncological outcomes, MHRT demonstrates non-inferiority to CFRT, while UHRT shows comparable survival outcomes to both MHRT and CFRT.
METHODS AND MATERIALS: Medline (PubMed), Embase,and Cochrane Database of Systematic Reviews were searched from inception through November 30, 2024. Randomized clinical trials or prospective/retrospective cohort studies comparing outcomes in patients with localized prostate cancer who received UHRT vs CFRT, UHRT vs MHRT, or MHRT vs CFRT. The main measurement outcomes included rates of acute and late GU (genitourinary) and GI (gastrointestinal) toxicity, OS, FFS, and BFS.
RESULTS: After reviewing 2938 reports, 41 unique studies including a total of 12,947 unique patients were selected. Regarding acute GI toxicity,MHRT showed a significantly higher incidence compared with CFRT (OR 1.37, 95%CI 1.10-1.71). Conversely, UHRT demonstrated a significantly lower risk compared with MHRT(OR 0.46, 95%CI 0.27-0.79). Notably, no statistically significant difference was observed between UHRT and CFRT. For other comparisons, there were no statistically significant differences in the proportion of acute GU toxicity across any comparison groups (MHRT vs CFRT, UHRT vs MHRT,or UHRT vs CFRT). Similarly,no significant differences were found in the prevalence of late GI or GU toxicity between MHRT and CFRT,or UHRT and MHRT. The pooled analysis suggested an improvement in 5-year FFS with MHRT compared with CFRT (HR 0.89, P = 0.04). However, sensitivity analysis indicated that this statistical finding was not robust and was largely driven by a single study. No statistically significant difference in 5-year OS was found between MHRT and CFRT. Similarly, no statistically significant differences in 5-year FFS and 5-year OS were observed between UHRT and CFRT. For UHRT vs MHRT, there were no significant differences in 3-year BFS and 3-year OS.
CONCLUSIONS: The findings suggest that UHRT is a promising strategy for localized prostate cancer. Regarding acute GI toxicity, both UHRT and CFRT demonstrated lower risks compared with MHRT. Regarding oncological outcomes, MHRT demonstrates non-inferiority to CFRT, while UHRT shows comparable survival outcomes to both MHRT and CFRT.