High-Dose Conformal Radiotherapy Reduces Prostate Cancer-Specific Mortality: Results of a Meta-analysis (Retracted article. See vol. 85, pg. 899, 2013)
High-Dose Conformal Radiotherapy Reduces Prostate Cancer-Specific Mortality: Results of a Meta-analysis (Retracted article. See vol. 85, pg. 899, 2013)
复制标题
DOI：
10.1016/j.ijrobp.2012.01.051
复制
发表时间：
2012-08-01
影响因子：
7
通讯作者：
Stefano, Eduardo Jose
中科院分区：
文献类型：
--
作者：
Viani, Gustavo Arruda;Bernardes da Silva, Lucas Godoi;Stefano, Eduardo Jose
目的：在Meta分析中确定接受高剂量适形放射治疗(HDRT)的前列腺癌患者的前列腺癌特异性死亡率(PCSM)、生化或临床失败(BCF)和总死亡率(OM)是否优于常规剂量放射治疗(CDRT)。方法与材料：系统地检索MEDLINE、Embase、CANCERLIT和Cochrane图书馆数据库以及年度会议记录，以确定比较适形高剂量放射治疗(HDRT)和CDRT治疗局限性前列腺癌的随机对照研究。结果：确定了5个符合研究标准的随机对照试验(2508例患者)。这些随机对照试验的综合结果显示，接受高强度放疗的患者在5年内PCSM和BCF率显著降低(分别为P=0.04和P<；0.0001)，PCSM和BCF5年的绝对风险降低(ARR)分别为1.7%和12.6%。两项试验对PCSM进行了10年的随访。这些试验的综合结果显示，就PCSM而言，HDRT具有统计学上的好处(p=0.03)。在亚组分析中，使用雄激素剥夺疗法的试验显示，发生良性循环的ARR为12.9%(需要治疗的数目=7.7p<；0.00001)，而不使用雄激素剥夺治疗的试验的ARR为13.6%(需要治疗的数目=7，p<；0.00001)。在接受HDRT和CDRT的患者中，5年和10年的OM发生率没有差异(分别为p=0.99和p=0.11)。结论：在使用构象技术增加总剂量的试验中，这项荟萃分析首次表明HDRT在预防疾病进展和前列腺癌特异性死亡方面优于CDRT。尽管我们的研究在评估ADT和HDRT的作用方面存在局限性，但我们的数据显示，在使用或不使用ADT的试验中，HDRT的BCF对HDRT ARMS没有好处。(C)2012年爱思唯尔公司。
Purpose: To determine in a meta-analysis whether prostate cancer-specific mortality (PCSM), biochemical or clinical failure (BCF), and overall mortality (OM) in men with localized prostate cancer treated with conformal high-dose radiotherapy (HDRT) are better than those in men treated with conventional-dose radiotherapy (CDRT).Methods and Materials: The MEDLINE, Embase, CANCERLIT, and Cochrane Library databases, as well as the proceedings of annual meetings, were systematically searched to identify randomized, controlled studies comparing conformal HDRT with CDRT for localized prostate cancer.Results: Five randomized, controlled trials (2508 patients) that met the study criteria were identified. Pooled results from these randomized, controlled trials showed a significant reduction in the incidence of PCSM and BCF rates at 5 years in patients treated with HDRT (p = 0.04 and p < 0.0001, respectively), with an absolute risk reduction (ARR) of PCSM and BCF at 5 years of 1.7% and 12.6%, respectively. Two trials evaluated PCSM with 10 years of follow up. The pooled results from these trials showed a statistical benefit for HDRT in terms of PCSM(p=0.03). In the subgroup analysis, trials that used androgen deprivation therapy (ADT) showed an ARR for BCF of 12.9% (number needed to treat=7.7, p < 0.00001), whereas trials without ADT had an ARR of 13.6% (number needed to treat=7, p < 0.00001). There was no difference in the OM rate at 5 and 10 years (p = 0.99 and p = 0.11, respectively) between the groups receiving HDRT and CDRT.Conclusions: This meta-analysis is the first study to show that HDRT is superior to CDRT in preventing disease progression and prostate cancerespecific death in trials that used conformational technique to increase the total dose. Despite the limitations of our study in evaluating the role of ADT and HDRT, our data show no benefit for HDRT arms in terms of BCF in trials with or without ADT. (C) 2012 Elsevier Inc.