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Radiotherapy-related toxicity for localized prostate cancer: meta-analysis comparing conventional or moderately hypofractionated vs. ultrahypofractionated protocols

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Abstract

Background

To compare toxicities in relation to standard radiation treatments [conventional fractionation RT (CRT) and moderate hypofractionated RT (MRT)] with ultrahypofractionated RT (URT) in the treatment of patients with localized PCa.

Methods

A searched was performed in Medline, Embase, Cochrane CENTRAL, and LILACS to January 2020 for studies comparing URT to CRT and/or MRT in relation to genitourinary (GU) and gastrointestinal (GI) toxicity in the treatment of patients with localized PCa. URT, MRT and CRT were defined as protocols delivering a daily dose of ≥5 Gy, 2.4–4.9 Gy, and <2.4 Gy per fractions regardless total dose, respectively.

Results

Eight studies with 2929 patients with localized PCa were included in the analysis. These eight studies did not find any difference between URT and MRT/CRT groups in relation to acute GU toxicity (21.0% × 23.8%, RD −0.04; 95% CI −0.13, 0.06; p = 0.46; I2 = 89%) and acute GI toxicity (4.9% × 6.9%, RD −0.03; 95% CI −0.07, 0.01; p = 0.21; I2 = 79%). Six studies did not find any difference between URT and MRT/CRT groups in relation to late GU toxicity (3.9% × 4.7%, RD −0.01; 95% CI −0.03, 0.00; p = 0.16; I2 = 19%) and late GI toxicity (2.1% × 3.5%, RD −0.01; 95% CI −0.03, 0.00; p = 0.05; I2 = 22%).

Conclusion

The present study suggests that acute GU/GI and late GU/GI toxicity are similar between URT and standard protocols. More studies with longer follow-ups directed to oncology outcomes are warranted before any recommendation on this topic.

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Authors and Affiliations

  1. Department of Urology, Faculdade de Medicina Do ABC, Santo André, São Paulo, Brazil

    Willy Baccaglini, Felipe P. A. Glina, Cristiano Linck Pazeto, André Marantes, Matheus Nascimento, Artur Farias & Sidney Glina

  2. Department of Urology, Albert Einstein Israelite Hospital, São Paulo, São Paulo, Brazil

    Willy Baccaglini

  3. Department of Radiation Oncology, Albert Einstein Israelite Hospital, São Paulo, São Paulo, Brazil

    Icaro T. de Carvalho

  4. Division of Radiation Oncology, London Regional Cancer Program, Western University, London, ON, Canada

    Lucas C. Mendez

  5. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Alessandro Tafuri

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  1. Willy Baccaglini
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Correspondence to Willy Baccaglini.

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Electronic supplementary material

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Supplementary data 1.

Acute genitourinary toxicity—comparison between URT and MRT/CRT considering only RCT. (PDF 185 KB)

Supplementary data 2.

Acute gastrointestinal toxicity—comparison between URT and MRT/CRT considering only RCT. (PDF 169 KB)

Supplementary data 3.

Late genitourinary toxicity—comparison between URT and MRT/CRT considering only RCT. (PDF 154 KB)

Supplementary data 4.

Late gastrointestinal toxicity—comparison between URT and MRT/CRT considering only RCT. (PDF 150 KB)

Appendices

Appendix 1

Newcastle–Ottawa checklists for observational comparative studies (cohorts)

figure a
figure b

Appendix 2

Risk of bias summary assessment for randomized clinical trials

figure c

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Baccaglini, W., de Carvalho, I.T., Glina, F.P.A. et al. Radiotherapy-related toxicity for localized prostate cancer: meta-analysis comparing conventional or moderately hypofractionated vs. ultrahypofractionated protocols. Clin Transl Oncol 24, 1425–1439 (2022). https://doi.org/10.1007/s12094-022-02790-2

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