Background: Radical prostatectomy (RP) is one possible curative treatment for localized prostate cancer. Despite that, up to 40% of patients will later relapse. Currently, post-operative radiotherapy (PORT) courses deliver 1.8–2 Gy daily to reach a total dose ranging between 64 and 74 Gy, completed in 7–8 weeks. Several articles reported encouraging data in terms of the effectiveness and the related toxicities using hypofractionation schedules. The objective of the present systematic review was to evaluate the clinical outcomes and toxicity of the use of hypofractionation in adjuvant/salvage prostate cancer treatments. Methods: Medline was searched via PubMed and Scopus from inception to July 2024 to retrieve studies on hypofractionation in adjuvant/salvage prostate cancer treatments. This study was conducted under PRISMA guidelines. Results: A total of 139 articles were identified from the initial search. Subsequently, the 139 studies were reviewed by title and abstract. Ninety-five studies were excluded due to being either abstracts or articles not available in English. In the second step, the full texts of 44 studies were reviewed. Eleven studies were excluded for being reviews, study protocols, or focused on SBRT treatments. Finally, 33 studies were included in our analysis, with a total number of 4269 patients. Of the 33 selected studies, 20 were retrospective trials and 11 were phase I/II prospective trials, while 2 studies were prospective phase III trials. The follow-up ranged from 18 to 217 months. Failure-free survival, for those with the longer follow-up, ranged between 85% and 91% at 3 years, 47 and 78.6% at 5 years and 51.5% at 10 years. Genitourinary (GU) and gastrointestinal acute toxicity was mild to moderate with similar rates across the normofractionated and hypofractionated groups. Acute grade-3 GU toxicity events were unusual, occurring in less than 4% of the cases overall. Conclusion: The present study is the first systematic review of the literature that includes the first two randomized phase III studies published in the literature. Hypofractionated treatment has been shown to be safe, effective, with moderate toxicity and not inferior to conventional RT, with good biochemical control rates.
背景：根治性前列腺切除术（RP）是局限性前列腺癌的一种可能治愈性治疗手段。尽管如此，高达40%的患者术后仍会复发。目前，术后放疗（PORT）方案通常每日给予1.8–2 Gy，总剂量在64至74 Gy之间，疗程持续7–8周。多篇文献报道了采用大分割放疗方案在疗效及相关毒性方面取得的积极数据。本系统综述旨在评估大分割放疗在前列腺癌辅助/挽救性治疗中的临床结局及毒性反应。 方法：通过PubMed和Scopus检索Medline数据库，自建库至2024年7月，收集关于前列腺癌辅助/挽救性治疗中大分割放疗的研究。本研究遵循PRISMA指南进行。 结果：初步检索共识别出139篇文献。随后对139项研究进行标题和摘要筛选，其中95项因仅为摘要或非英文文献被排除。第二步，对44项研究的全文进行审阅，其中11项因属于综述、研究方案或聚焦于立体定向放射治疗（SBRT）而被排除。最终，33项研究纳入分析，共涉及4269例患者。在入选的33项研究中，20项为回顾性试验，11项为I/II期前瞻性试验，2项为前瞻性III期试验。随访时间范围为18至217个月。在随访时间较长的研究中，无失败生存率在3年时为85%至91%，5年时为47%至78.6%，10年时为51.5%。泌尿生殖系统（GU）和胃肠道急性毒性反应为轻度至中度，常规分割组与大分割组的发生率相似。急性3级GU毒性事件较为少见，总体发生率低于4%。 结论：本研究是首次纳入文献中已发表的前两项随机III期试验的系统综述。大分割放疗已被证明安全有效，毒性反应适中，且不劣于常规放疗，具有良好的生化控制率。
肿瘤(癌症)患者之家