Rectal/urinary toxicity after hypofractionated vs conventional radiotherapy in low/intermediate risk localized prostate cancer: Systematic review and meta analysis

R. Di Franco, V. Borzillo, V. Ravo, G. Ametrano, S. Falivene, F. Cammarota, S. Rossetti, F.J. Romano, C. D'Aniello, C. Cavaliere, G. Iovane, R. Piscitelli, M. Berretta, P. Muto, G. Facchini

Research output: Contribution to journalArticle

Abstract

Purpose: The aim of this review was to compare radiation toxicity in Localized Prostate Cancer (LPC) patients who underwent conventional fractionation (CV), hypofractionated (HYPO) or extreme hypofractionated (eHYPO) radiotherapy. We analyzed the impact of technological innovation on the management of prostate cancer, attempting to make a meta-analysis of randomized trials. Methods: PubMed database has been explored for studies concerning acute and late urinary/gastrointestinal toxicity in low/intermediate risk LPC patients after receiving radiotherapy. Studies were then gathered into 5 groups: detected acute and chronic toxicity data from phase II non randomized trials were analyzed and Odds Ratio (OR) was calculated by comparing the number of patients with G0-1 toxicity and those with toxicity > G2 in the studied groups. A meta-analysis of prospective randomized trials was also carried out. Results: The initial search yielded 575 results, but only 32 manuscripts met all eligibility requirements: in terms of radiation-induced side effects, such as gastrointestinal and genitourinary acute and late toxicity, hypofractionated 3DCRT seemed to be more advantageous than 3DCRT with conventional fractionation as well as IMRT with conventional fractionation compared to 3DCRT with conventional fractionation; furthermore, IMRT hypofractionated technique appeared more advantageous than IMRT with conventional fractionation in late toxicities. Randomized trials meta-analysis disclosed an advantage in terms of acute gastrointestinal and late genitourinary toxicity for Hypofractionated schemes. Conclusions: Although our analysis pointed out a more favorable toxicity profile in terms of gastrointestinal acute side effects of conventional radiotherapy schemes compared to hypofractionated ones, prospective randomized trials are needed to better understand the real incidence of rectal and urinary toxicity in patients receiving radiotherapy for localized prostate cancer.
Original languageEnglish
Pages (from-to)17383-17395
Number of pages13
JournalOncotarget
Volume8
Issue number10
Publication statusPublished - 2017

Keywords

  • Meta-analysis
  • Prostate cancer
  • Radiotherapy
  • Review
  • Toxicity
  • acute toxicity
  • cancer localization
  • cancer radiotherapy
  • chronic toxicity
  • gastrointestinal toxicity
  • human
  • hypofractionated radiotherapy
  • intermediate risk patient
  • low risk patient
  • meta analysis
  • phase 2 clinical trial (topic)
  • prospective study
  • prostate cancer
  • radiation hazard
  • radiation injury
  • radiological procedures
  • randomized controlled trial (topic)
  • rectum injury
  • risk assessment
  • systematic review
  • urinary tract injury
  • urogenital tract disease
  • adverse effects
  • intensity modulated radiation therapy
  • male
  • pathology
  • procedures
  • Prostatic Neoplasms
  • radiation dose fractionation
  • Radiation Injuries
  • radiation response
  • Rectal Diseases
  • rectum
  • Urination Disorders
  • Dose Fractionation
  • Humans
  • Male
  • Radiotherapy, Intensity-Modulated
  • Randomized Controlled Trials as Topic
  • Rectum

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