Background: Focal boost radiotherapy was developed to deliver elevated doses to functional sub-volumes within a target. Such a technique was hypothesized to improve treatment outcomes without increasing toxicity in prostate cancer treatment. Purpose: To summarize and evaluate the efficacy and variability of focal boost radiotherapy by reviewing focal boost planning studies and clinical trials that have been published in the last ten years. Methods: Published reports of focal boost radiotherapy, that specifically incorporate dose escalation to intra-prostatic lesions (IPLs), were reviewed and summarized. Correlations between acute/late ≥G2 genitourinary (GU) or gastrointestinal (GI) toxicity and clinical factors were determined by a meta-analysis. Results: By reviewing and summarizing 34 planning studies and 35 trials, a significant dose escalation to the GTV and thus higher tumor control of focal boost radiotherapy were reported consistently by all reviewed studies. Reviewed trials reported a not significant difference in toxicity between focal boost and conventional radiotherapy. Acute ≥G2 GU and late ≥G2 GI toxicities were reported the most and least prevalent, respectively, and a negative correlation was found between the rate of toxicity and proportion of low-risk or intermediate-risk patients in the cohort. Conclusion: Focal boost prostate cancer radiotherapy has the potential to be a new standard of care.
背景：局部推量放疗技术旨在对靶区内功能性亚区实施更高剂量照射。该技术被假设可在不增加毒性的前提下改善前列腺癌治疗效果。目的：通过综述近十年来发表的局部推量放疗计划设计与临床试验，总结评估该技术的疗效与差异性。方法：系统回顾并总结已发表的针对前列腺内病灶实施剂量递增的局部推量放疗研究报告。通过荟萃分析确定急性/晚期≥2级泌尿生殖系统或胃肠道毒性与临床因素的相关性。结果：通过对34项计划设计研究和35项临床试验的综述，所有研究均一致报道局部推量放疗可实现显著的肿瘤靶区剂量提升，从而获得更高的肿瘤控制率。各项试验表明局部推量放疗与传统放疗的毒性差异无统计学意义。其中急性≥2级泌尿生殖系统毒性最为常见，晚期≥2级胃肠道毒性发生率最低，且毒性发生率与队列中低危或中危患者比例呈负相关。结论：局部推量放疗有望成为前列腺癌治疗的新标准方案。
Focal Boost in Prostate Cancer Radiotherapy: A Review of Planning Studies and Clinical Trials
肿瘤(癌症)患者之家