Rectal/urinary toxicity after hypofractionated vs. Conventional radiotherapy in high risk prostate cancer: Systematic review and meta analysis

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

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The aim of our report was to review the literature concerning the toxicity of radiation therapy in patients treated for high-risk prostate cancer, and to evaluate the differences in toxicity between conventional fractionation and hypofractionated treatments, in view of different techniques used in high-risk prostate cancer patients. MATERIALS AND METHODS: PubMed database has been explored for studies concerning acute and late urinary/gastrointestinal toxicity in high-risk prostate cancer patients treated with radiotherapy. Prospective studies, concerning potential relationship between acute/late genitourinary (GU)/gastrointestinal (GI) toxicity and prostate radiotherapy in patients with high-risk prostate cancer, were included in the final analysis. Data collected from single arm, phase II non-randomized and randomized studies have been evaluated to perform odds ratio for toxicity risk. Furthermore, meta-analysis randomized prospective trials were considered suitable because they had recruited high-risk prostate cancer patients who didn't undergo surgery, with available data on ≥ G2 toxicity frequency. RESULTS: The initial search provided 606 results, but only 35 manuscripts met all eligibility requirements and were included in this report. In order to perform odds ratio we observed a decrease in late gastrointestinal toxicity for patients treated with hypofractionated schemes compared to CV treated ones. Among patients who underwent conventional treatment, SIB seemed to decrease acute genitourinary side effects; SIB-Hypo treated patients suffered less toxicity than patients treated with hypofrac-tionated-sequential boost schemes. Hypo-SIB schemes would seem less toxic in terms of acute gastrointestinal and late genitourinary side effects than CV-SIB. Therefore, our focus shifted to 6 clinical trials evaluating genitourinary and gastrointestinal toxicity in patients who had been randomized to receive conventional fractionation or hypofractionated treatment, in both cases with IMRT technology. Our meta-analysis of these randomized trials involving patients with high-risk prostate cancer showed a statistically significant increase in late genitourinary toxicity for hypo-treated patients; no difference was observed in acute genitourinary/gastrointestinal toxicity, and in late gastrointestinal toxicity. CONCLUSIONS: Our analysis doesn't want to establish a definitive truth; very few trials assessed only high risk-class patients. Our purpose is to stimulate further randomized prospective trials focusing both on the effectiveness and toxicity profile (toxicity/effectiveness ratio), taking into account the use of different technologies and doses.
Original languageEnglish
Pages (from-to)3563-3575
Number of pages13
JournalEuropean Review for Medical and Pharmacological Sciences
Volume21
Issue number16
Publication statusPublished - 2017

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Meta-Analysis
Prostatic Neoplasms
Radiotherapy
Odds Ratio
Technology
Manuscripts
Poisons
PubMed
Prostate
Therapeutics
Clinical Trials
Databases
Prospective Studies

Keywords

  • High risk
  • Meta-analysis
  • Prostate cancer
  • Radiotherapy
  • Review
  • Toxicity
  • cancer patient
  • cancer radiotherapy
  • cancer risk
  • gastrointestinal toxicity
  • high risk patient
  • human
  • hypofractionated radiotherapy
  • information processing
  • intensity modulated radiation therapy
  • intermethod comparison
  • meta analysis
  • prostate cancer
  • radiation dose
  • radiation injury
  • randomized controlled trial (topic)
  • rectum disease
  • risk reduction
  • systematic review
  • urinary tract disease
  • urogenital tract disease

Cite this

Rectal/urinary toxicity after hypofractionated vs. Conventional radiotherapy in high risk prostate cancer: Systematic review and meta analysis. / Di Franco, R.; Borzillo, V.; Ravo, V.; Trano, G.; Cammarota, F.; Rossetti, S.; Romano, F.J.; D'Aniello, C.; Cavaliere, C.; Iovane, G.; Porricelli, M.A.; Muto, M.; Berretta, M.; Facchini, G.; Muto, P.

In: European Review for Medical and Pharmacological Sciences, Vol. 21, No. 16, 2017, p. 3563-3575.

Research output: Contribution to journalArticle

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note = "Export Date: 20 February 2018 CODEN: RESFD Correspondence Address: Di Franco, R.; Progetto ONCONET2.0, Linea Progettuale 14 per l'Implementazione della Prevenzione e Diagnosi Precoce del Tumore alla Prostata e TesticoloItaly; email: rosselladifrancort@gmail.com",
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journal = "European Review for Medical and Pharmacological Sciences",
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TY - JOUR

T1 - Rectal/urinary toxicity after hypofractionated vs. Conventional radiotherapy in high risk prostate cancer: Systematic review and meta analysis

AU - Di Franco, R.

AU - Borzillo, V.

AU - Ravo, V.

AU - Trano, G.

AU - Cammarota, F.

AU - Rossetti, S.

AU - Romano, F.J.

AU - D'Aniello, C.

AU - Cavaliere, C.

AU - Iovane, G.

AU - Porricelli, M.A.

AU - Muto, M.

AU - Berretta, M.

AU - Facchini, G.

AU - Muto, P.

N1 - Export Date: 20 February 2018 CODEN: RESFD Correspondence Address: Di Franco, R.; Progetto ONCONET2.0, Linea Progettuale 14 per l'Implementazione della Prevenzione e Diagnosi Precoce del Tumore alla Prostata e TesticoloItaly; email: rosselladifrancort@gmail.com

PY - 2017

Y1 - 2017

N2 - OBJECTIVE: The aim of our report was to review the literature concerning the toxicity of radiation therapy in patients treated for high-risk prostate cancer, and to evaluate the differences in toxicity between conventional fractionation and hypofractionated treatments, in view of different techniques used in high-risk prostate cancer patients. MATERIALS AND METHODS: PubMed database has been explored for studies concerning acute and late urinary/gastrointestinal toxicity in high-risk prostate cancer patients treated with radiotherapy. Prospective studies, concerning potential relationship between acute/late genitourinary (GU)/gastrointestinal (GI) toxicity and prostate radiotherapy in patients with high-risk prostate cancer, were included in the final analysis. Data collected from single arm, phase II non-randomized and randomized studies have been evaluated to perform odds ratio for toxicity risk. Furthermore, meta-analysis randomized prospective trials were considered suitable because they had recruited high-risk prostate cancer patients who didn't undergo surgery, with available data on ≥ G2 toxicity frequency. RESULTS: The initial search provided 606 results, but only 35 manuscripts met all eligibility requirements and were included in this report. In order to perform odds ratio we observed a decrease in late gastrointestinal toxicity for patients treated with hypofractionated schemes compared to CV treated ones. Among patients who underwent conventional treatment, SIB seemed to decrease acute genitourinary side effects; SIB-Hypo treated patients suffered less toxicity than patients treated with hypofrac-tionated-sequential boost schemes. Hypo-SIB schemes would seem less toxic in terms of acute gastrointestinal and late genitourinary side effects than CV-SIB. Therefore, our focus shifted to 6 clinical trials evaluating genitourinary and gastrointestinal toxicity in patients who had been randomized to receive conventional fractionation or hypofractionated treatment, in both cases with IMRT technology. Our meta-analysis of these randomized trials involving patients with high-risk prostate cancer showed a statistically significant increase in late genitourinary toxicity for hypo-treated patients; no difference was observed in acute genitourinary/gastrointestinal toxicity, and in late gastrointestinal toxicity. CONCLUSIONS: Our analysis doesn't want to establish a definitive truth; very few trials assessed only high risk-class patients. Our purpose is to stimulate further randomized prospective trials focusing both on the effectiveness and toxicity profile (toxicity/effectiveness ratio), taking into account the use of different technologies and doses.

AB - OBJECTIVE: The aim of our report was to review the literature concerning the toxicity of radiation therapy in patients treated for high-risk prostate cancer, and to evaluate the differences in toxicity between conventional fractionation and hypofractionated treatments, in view of different techniques used in high-risk prostate cancer patients. MATERIALS AND METHODS: PubMed database has been explored for studies concerning acute and late urinary/gastrointestinal toxicity in high-risk prostate cancer patients treated with radiotherapy. Prospective studies, concerning potential relationship between acute/late genitourinary (GU)/gastrointestinal (GI) toxicity and prostate radiotherapy in patients with high-risk prostate cancer, were included in the final analysis. Data collected from single arm, phase II non-randomized and randomized studies have been evaluated to perform odds ratio for toxicity risk. Furthermore, meta-analysis randomized prospective trials were considered suitable because they had recruited high-risk prostate cancer patients who didn't undergo surgery, with available data on ≥ G2 toxicity frequency. RESULTS: The initial search provided 606 results, but only 35 manuscripts met all eligibility requirements and were included in this report. In order to perform odds ratio we observed a decrease in late gastrointestinal toxicity for patients treated with hypofractionated schemes compared to CV treated ones. Among patients who underwent conventional treatment, SIB seemed to decrease acute genitourinary side effects; SIB-Hypo treated patients suffered less toxicity than patients treated with hypofrac-tionated-sequential boost schemes. Hypo-SIB schemes would seem less toxic in terms of acute gastrointestinal and late genitourinary side effects than CV-SIB. Therefore, our focus shifted to 6 clinical trials evaluating genitourinary and gastrointestinal toxicity in patients who had been randomized to receive conventional fractionation or hypofractionated treatment, in both cases with IMRT technology. Our meta-analysis of these randomized trials involving patients with high-risk prostate cancer showed a statistically significant increase in late genitourinary toxicity for hypo-treated patients; no difference was observed in acute genitourinary/gastrointestinal toxicity, and in late gastrointestinal toxicity. CONCLUSIONS: Our analysis doesn't want to establish a definitive truth; very few trials assessed only high risk-class patients. Our purpose is to stimulate further randomized prospective trials focusing both on the effectiveness and toxicity profile (toxicity/effectiveness ratio), taking into account the use of different technologies and doses.

KW - High risk

KW - Meta-analysis

KW - Prostate cancer

KW - Radiotherapy

KW - Review

KW - Toxicity

KW - cancer patient

KW - cancer radiotherapy

KW - cancer risk

KW - gastrointestinal toxicity

KW - high risk patient

KW - human

KW - hypofractionated radiotherapy

KW - information processing

KW - intensity modulated radiation therapy

KW - intermethod comparison

KW - meta analysis

KW - prostate cancer

KW - radiation dose

KW - radiation injury

KW - randomized controlled trial (topic)

KW - rectum disease

KW - risk reduction

KW - systematic review

KW - urinary tract disease

KW - urogenital tract disease

M3 - Article

VL - 21

SP - 3563

EP - 3575

JO - European Review for Medical and Pharmacological Sciences

JF - European Review for Medical and Pharmacological Sciences

SN - 1128-3602

IS - 16

ER -