G Francolini1, B Detti2, C Becherini1, S Caini3, G Ingrosso4, Vanessa Di Cataldo1, G Stocchi1, V Salvestrini1, A Lancia5, D Scartoni6, I Giacomelli6, A Sardaro7, R Carbonara8, S Borghesi9, C Aristei4, L Livi1. 1. Radiation Oncology Unit, University of Florence, Florence, Italy. 2. Radiation Oncology Unit, University of Florence, Florence, Italy. Electronic address: beatrice.detti@aouc.unifi.it. 3. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy. 4. Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Italy. 5. Department of Medical Sciences and Infectious Disease, Radiation Oncology Unit, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy. 6. Proton Treatment Center, Azienda Provinciale Per i Servizi Sanitari, Trento, Italy. 7. Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy. 8. Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, BA, Italy. 9. Radiotherapy Department, Azienda USL Toscana Sud Est, San Donato Hospital, Arezzo, Italy.
Abstract
BACKGROUND: Moderately hypofractionated radiotherapy (RT) currently represents the standard RT approach for all prostate cancer (PCa) risk categories. We performed a systematic review and meta-analysis of available literature, focusing on acute and late genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) of moderate hypofractionation for localized PCa. MATERIALS AND METHODS: Literature search was performed and two independent reviewers selected the records according to the following Population (P) Intervention (I) Comparator (C) and Outcomes (O) (PICO) question: "In patients affected by localized PCa (P), moderately hypofractionated RT (defined as a treatment schedule providing a single dose per fraction of 3-4.5 Gy) (I) can be considered equivalent to conventionally fractionated RT (C) in terms of G > 2 GI and GU acute and late adverse events (O)?". Bias assessment was performed using Cochrane Cochrane Collaboration's Tool for Assessing Risk of Bias. RESULTS: Thirteen records were identified and a meta-analysis was performed. Risk of acute GI and GU > 2 adverse events in the moderately hypofractionated arm was increased by 9.8 % (95 %CI 4.8 %-14.7 %; I2 = 57 %) and 1.5 % (95 % CI -1.5 %-4.4 %; I2 = 0%), respectively. DISCUSSION: Overall, majority of trials included in our meta-analysis suggested that moderately hypofractionated RT is equivalent, in terms of GI and GU adverse events, to conventional fractionation. Pooled analysis showed a trend to increased GI toxicity after hypofractionated treatment, but this might be related to dose escalation rather than hypofractionation.
BACKGROUND: Moderately hypofractionated radiotherapy (RT) currently represents the standard RT approach for all prostate cancer (PCa) risk categories. We performed a systematic review and meta-analysis of available literature, focusing on acute and late genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) of moderate hypofractionation for localized PCa. MATERIALS AND METHODS: Literature search was performed and two independent reviewers selected the records according to the following Population (P) Intervention (I) Comparator (C) and Outcomes (O) (PICO) question: "In patients affected by localized PCa (P), moderately hypofractionated RT (defined as a treatment schedule providing a single dose per fraction of 3-4.5 Gy) (I) can be considered equivalent to conventionally fractionated RT (C) in terms of G > 2 GI and GU acute and late adverse events (O)?". Bias assessment was performed using Cochrane Cochrane Collaboration's Tool for Assessing Risk of Bias. RESULTS: Thirteen records were identified and a meta-analysis was performed. Risk of acute GI and GU > 2 adverse events in the moderately hypofractionated arm was increased by 9.8 % (95 %CI 4.8 %-14.7 %; I2 = 57 %) and 1.5 % (95 % CI -1.5 %-4.4 %; I2 = 0%), respectively. DISCUSSION: Overall, majority of trials included in our meta-analysis suggested that moderately hypofractionated RT is equivalent, in terms of GI and GU adverse events, to conventional fractionation. Pooled analysis showed a trend to increased GI toxicity after hypofractionated treatment, but this might be related to dose escalation rather than hypofractionation.
Authors: Rodrigo Muelas-Soria; Rafael García-Mollá; Virginia Morillo-Macías; Jorge Bonaque-Alandí; Patricia Sorribes-Carreras; Francisco García-Piñón; Carlos Ferrer-Albiach Journal: Biomedicines Date: 2022-06-13