Hypofractionated Radiation Therapy for Localized Prostate Cancer: Executive Summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline
Hypofractionated Radiation Therapy for Localized Prostate Cancer: Executive Summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline
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DOI：
10.1016/j.prro.2018.08.002
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发表时间：
2018-11-01
影响因子：
3.3
通讯作者：
Sandler, Howard
中科院分区：
文献类型：
--
作者：
Morgan, Scott C.;Hoffman, Karen;Sandler, Howard
目的：本指南的目的是为局部前列腺癌的中度低分割（每分数240-340 cGy）和超低分割（每分数500 cGy或更多）放射治疗提出建议。方法和材料：美国放射肿瘤学学会召集了一个工作组来解决8个关键问题，包括中等和超低分割放射治疗的适当适应症和剂量分割，以及技术问题，包括正常组织剂量限制、治疗量、图像引导和强度调制放射治疗的使用。建议是基于系统的文献综述，并使用预定义的共识建立方法和学会批准的工具来分级证据质量和建议强度。结果：基于高质量的证据，对于选择外束放射治疗的患者，在风险组间给予适度的低分割治疗达成了强烈的共识。该工作组有条件地建议对低风险和中风险前列腺癌提供超低分割放疗，但强烈鼓励对临床试验或多机构登记的中风险患者进行治疗。对于高危患者，工作组有条件地建议不常规使用超低分割外束放射治疗。对于任何低分割方法，工作组强烈建议图像引导放射治疗和避免非调制三维适形技术。结论：低分割放射治疗在成本和便便性方面对患者具有重要的潜在优势，这些建议旨在为局限性前列腺癌的中度低分割和超低分割治疗提供指导。目前证据基础的局限性，特别是对于超低分割，强调了支持大规模随机临床试验的必要性，并强调了临床医生和患者之间共同决策的重要性。(C) 2018年美国放射肿瘤学会。Elsevier Inc.出版。版权所有。
Purpose: The aim of this guideline is to present recommendations regarding moderately hypofractionated (240-340 cGy per fraction) and ultrahypofractionated (500 cGy or more per fraction) radiation therapy for localized prostate cancer.Methods and Materials: The American Society for Radiation Oncology convened a task force to address 8 key questions on appropriate indications and dose-fractionation for moderately and ultrahypofractionated radiation therapy, as well as technical issues, including normal tissue dose constraints, treatment volumes, and use of image guided and intensity modulated radiation therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and Society-approved tools for grading evidence quality and recommendation strength.Results: Based on high-quality evidence, strong consensus was reached for offering moderate hypofractionation across risk groups to patients choosing external beam radiation therapy. The task force conditionally recommends ultrahypofractionated radiation may be offered for low- and intermediate-risk prostate cancer but strongly encourages treatment of intermediate-risk patients on a clinical trial or multi-institutional registry. For high-risk patients, the task force conditionally recommends against routine use of ultrahypofractionated external beam radiation therapy. With any hypofractionated approach, the task force strongly recommends image guided radiation therapy and avoidance of nonmodulated 3-dimensional conformal techniques.Conclusions: Hypofractionated radiation therapy provides important potential advantages in cost and convenience for patients, and these recommendations are intended to provide guidance on moderate hypofractionation and ultrahypofractionation for localized prostate cancer. The limits in the current evidentiary base-especially for ultrahypofractionation-highlight the imperative to support large-scale randomized clinical trials and underscore the importance of shared decision making between clinicians and patients. (C) 2018 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.