European urology oncology · 2025
Two-fraction Versus Five-fraction Stereotactic Body Radiotherapy for Intermediate-risk Prostate Cancer: The TOFFEE Meta-analysis of Individual Patient Data from Four Prospective Trials.
СтатьяМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Udovicich Cristian, Cheung Patrick, Chu William, Chung Hans, Detsky Jay, Liu Stanley, Morton Gerard, Szumacher Ewa, Tseng Chia-Lin, Vesprini Danny, Ong Wee Loon, Kennedy Thomas, Davidson Melanie, Ravi Ananth, McGuffin Merrylee, Zhang Liying, Mamedov Alexandre, Deabreu Andrea, Kulasingham-Poon Meghan, Loblaw Andrew
Аннотация
BACKGROUND AND OBJECTIVE: Recent randomized controlled trials have demonstrated the efficacy of five-fraction stereotactic body radiotherapy (5F-SBRT) for prostate cancer (PC), but there is no comparative evidence for fewer fractions. We compare outcomes of prostate two-fraction SBRT (2F-SBRT) and 5F-SBRT using prospective data for patients with intermediate-risk (IR) PC.
METHODS: This meta-analysis of individual patient data evaluated IR-PC from four prospective trials of prostate SBRT (two trials each of 2F- and 5F-SBRT). The primary endpoint was the cumulative incidence of biochemical failure (BCF). Secondary endpoints included the cumulative incidence of distant metastases (DM) and patient-reported quality of life (QoL).
KEY FINDINGS AND LIMITATIONS: Of the 199 patients meeting the eligibility criteria, 143 (72%) were in the 5F-SBRT group and 56 (28%) were in the 2F-SBRT group. Median follow-up was 9.4 years. There was no significant difference in BCF with a 5-year cumulative incidence of 3.6% (95% CI 0-8.6%) in the 2F-SBRT group and 6.0% (95% CI 1.8-10.2%) in the 5F-SBRT group (p = 0.73). There was no significant difference in DM incidence. We found no differences in acute and late urinary or bowel QoL. Limitations include the non-randomized comparison.
CONCLUSIONS AND CLINICAL IMPLICATIONS: We report the first prospective comparison of prostate 2F-SBRT and 5F-SBRT. We found no significant difference in efficacy, or in urinary or bowel QoL. This meta-analysis further encourages the potential of 2F-SBRT to be a standard-of-care option for IR PC.
METHODS: This meta-analysis of individual patient data evaluated IR-PC from four prospective trials of prostate SBRT (two trials each of 2F- and 5F-SBRT). The primary endpoint was the cumulative incidence of biochemical failure (BCF). Secondary endpoints included the cumulative incidence of distant metastases (DM) and patient-reported quality of life (QoL).
KEY FINDINGS AND LIMITATIONS: Of the 199 patients meeting the eligibility criteria, 143 (72%) were in the 5F-SBRT group and 56 (28%) were in the 2F-SBRT group. Median follow-up was 9.4 years. There was no significant difference in BCF with a 5-year cumulative incidence of 3.6% (95% CI 0-8.6%) in the 2F-SBRT group and 6.0% (95% CI 1.8-10.2%) in the 5F-SBRT group (p = 0.73). There was no significant difference in DM incidence. We found no differences in acute and late urinary or bowel QoL. Limitations include the non-randomized comparison.
CONCLUSIONS AND CLINICAL IMPLICATIONS: We report the first prospective comparison of prostate 2F-SBRT and 5F-SBRT. We found no significant difference in efficacy, or in urinary or bowel QoL. This meta-analysis further encourages the potential of 2F-SBRT to be a standard-of-care option for IR PC.