初次确定性放疗后使用立体定向体放疗 (SBRT) 对前列腺进行再次放疗--近期试验的系统回顾和荟萃分析

IF 2.7 3区医学 Q3 ONCOLOGY Clinical and Translational Radiation Oncology Pub Date : 2024-06-20 DOI:10.1016/j.ctro.2024.100806

Christina Schröder , Hongjian Tang , Bianca Lenffer , André Buchali , Daniel Rudolf Zwahlen , Robert Förster , Paul Windisch

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引用次数: 0

摘要

背景关于前列腺癌明确放疗后使用立体定向体放射治疗（SBRT）进行前列腺再照射的数据越来越多，近年来使用C臂LINAC或磁共振LINAC进行前列腺再照射的证据也越来越多。因此，我们开展了这项关于前列腺再照射的系统综述和荟萃分析，其中包括 2020 年至 2023 年发表的研究，作为现有荟萃分析的更新。方法我们于 2023 年 10 月在 PubMed 和 Embase 数据库中进行了检索，查询包括 "重复"、"放疗"、"前列腺"、"再照射"、"再治疗"、"SBRT"、"再治疗 "的组合。发表日期定为 2020 年至 2023 年。语言方面没有限制。我们遵循了系统综述和荟萃分析首选报告项目（PRISMA）的建议。数据提取后，通过计算 I2 进行了异质性检验。采用随机效应模型和限制性最大似然估计法来估计综合效应。漏斗图的不对称性通过目测和Egger检验进行评估，以估计是否存在发表偏倚和/或小规模研究偏倚。纳入研究报告的急性≥2级（G2）泌尿生殖系统（GU）和胃肠道（GI）毒性发生率分别为0.0-30.0%和0.0-25.0%。晚期≥G2的泌尿系统和胃肠道毒性分别为4.0-51.8%和0.0-25.0%。急性GU和GI毒性≥G2的总发生率分别为13%（95% CI：7-18%）和2%（95% CI：0-4%）。晚期胃肠道和消化道毒性≥G2的汇总率分别为25%（95% CI：14-35%）和5%（95% CI：1-9%）。汇总的 2 年无生化复发生存率为 72 %（95 % CI：64-92 %）。需要进一步的前瞻性数据。

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Re-irradiation to the prostate using stereotactic body radiotherapy (SBRT) after initial definitive radiotherapy – A systematic review and meta-analysis of recent trials

Background

There is increasing data on re-irradiation to the prostate using stereotactic body radiotherapy (SBRT) after definitive radiotherapy for prostate cancer, with increasing evidence on prostate re-irradiation using a C-arm LINAC or an MR LINAC in recent years. We therefore conducted this systematic review and meta-analysis on prostate re-irradiation including studies published from 2020 to 2023, to serve as an update on existing meta-analysis.

Methods

We searched the PubMed and Embase databases in October 2023 with queries including combinations of “repeat”, “radiotherapy”, “prostate”, “re-irradiation”, “reirradiation”, “re treatment”, “SBRT”, “retreatment”. Publication date was set to be from 2020 to 2023. There was no limitation regarding language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. After data extraction, heterogeneity testing was done by calculating the I². A random effects model with a restricted maximum likelihood estimator was used to estimate the combined effect. Funnel plot asymmetry was assessed visually and using Egger’s test to estimate the presence of publication and/or small study bias.

Results

14 publications were included in the systematic review. The rates of acute ≥ grade 2 (G2) genitourinary (GU) and gastrointestinal (GI) toxicities reported in the included studies ranged from 0.0-30.0 % and 0.0–25.0 % respectively. For late ≥ G2 GU and GI toxicity, the ranges are 4.0–51.8 % and 0.0–25.0 %. The pooled rate of acute GU and GI toxicity ≥ G2 were 13 % (95 % CI: 7–18 %) and 2 % (95 % CI: 0–4 %). For late GU and GI toxicity ≥ G2 the pooled rates were 25 % (95 % CI: 14–35 %) and 5 % (95 % CI: 1–9 %). The pooled 2-year biochemical recurrence-free survival was 72 % (95 % CI: 64–92 %).