The role of image-guided radiotherapy in prostate cancer: A systematic review and meta-analysis

作者全名："Wang, Shilin; Tang, Wen; Luo, Huanli; Jin, Fu; Wang, Ying"

作者地址："[Wang, Shilin; Luo, Huanli; Jin, Fu; Wang, Ying] Chongqing Univ, Dept Radiat Oncol, Canc Hosp, Chongqing 400030, Peoples R China; [Tang, Wen] Chongqing Med Univ, Dept Rehabil, Affiliated Hosp 2, Chongqing 400010, Peoples R China"

通信作者："Jin, F; Wang, Y (通讯作者)，Chongqing Univ, Dept Radiat Oncol, Canc Hosp, Chongqing 400030, Peoples R China."

来源：CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY

ESI学科分类：　

WOS号：WOS:000927150300013

JCR分区：Q2

影响因子：2.7

年份：2023

卷号：38

期号：　

开始页：81

结束页：89

文献类型：Review

关键词：Image-guided radiotherapy; Prostate cancer; Meta-analysis; Survival; Gastrointestinal toxicity; Genitourinary toxicity; Second cancer mortality

摘要："Background: Image-guided radiotherapy (IGRT) has gradually been widely promoted in clinical procedure. However, there has been no consensus on the effects of IGRT on toxicity and survival, and no clear level 1 evidence has even been promulgated. Methods: Medline, EMBASE, PubMed, Cochrane databases and ClinicalTrials.gov were searched for studies comparing IGRT vs non-IGRT or higher frequency IGRT vs lower frequency IGRT during prostate radiotherapy, indexed from database inception to April 2022. Results: The review included 18 studies (3 randomized clinical trial and 15 cohort studies) involving 6521 men, with a median duration of patient follow-up of 46.2 months in the IGRT group vs 52.7 months in the control group. The meta-analysis demonstrated that IGRT significantly reduced acute GU (risk ratio [RR], 0.78; 95 % confidence interval [CI], 0.69-0.88; P < 0.001 [9 studies]) and GI toxicity (RR, 0.49; 95 % CI, 0.35-0.68; P < 0.001 [4 studies]) and late GI toxicity (HR, 0.25; 95 % CI, 0.07-0.87; P = 0.03 [3 studies]) compared with non-IGRT. Meanwhile, compared with prospective studies, retrospective studies showed that IGRT had a more significant effect in reducing the late GI toxicity. Compared with non-daily IGRT, daily IGRT significantly improved 3-year PRFS (HR, 0.45; 95 % CI, 0.28-0.72; P = 0.001 [2 studies]) and BFFS (HR, 0.57; 95 % CI, 0.39-0.83; P = 0.003 [3 studies]). Furthermore, high-frequency daily IGRT could lead to greater 3-year BFFS benefit in prostate cancer patients than weekly IGRT. However, no significant effects of IGRT on acute rectal toxicity, late GU toxicity, 5-year OS and SCM were found. Conclusions: For men receiving prostate radiotherapy, IGRT was associated with an improvement in biochemical tumor control and a reduction in GI and acute GU toxicity, but did not significantly improve 5-year OS or increase 5-year SCM."

基金机构：Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) [2022DBXM005]

基金资助正文：The data analysis was supported by Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) under Grant No. 2022DBXM005.