Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review.

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Etat: Public
Version: Final published version
Licence: CC BY-NC-ND 4.0
ID Serval
serval:BIB_CF7FA8A5C5CA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review.
Périodique
Prostate international
Auteur(s)
Feutren T., Herrera F.G.
ISSN
2287-8882 (Print)
ISSN-L
2287-8882
Statut éditorial
Publié
Date de publication
09/2018
Peer-reviewed
Oui
Volume
6
Numéro
3
Pages
75-87
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Résumé
Radiation therapy (RT) is a curative treatment option for localized prostate cancer. Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule (IDN) is an emerging treatment option that involves the prophylactic irradiation of the whole prostate while increasing RT doses to the visible prostatic tumor. Because of the lack of large multicentre trials, a systematic review was performed in an attempt to get an overview on the feasibility and efficacy of focal dose escalation to the IDN. A bibliographic search for articles in English, which were listed in MEDLINE from 2000 to 2016 to identify publications on RT with focal directed boost to the IDN, was performed. The review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Twenty-two articles describing 1,378 patients treated with RT using focal boost were identified and fulfilled the selection criteria. Intensity-modulated radiation therapy (IMRT) was used in 720 patients (52.3%), volumetric modulated arc therapy was used in 45 patients (3.3%), stereotactic body radiation therapy (SBRT) in 113 patients (8.2%), and low-dose rate and high-dose rate brachytherapy (BT) were used in 305 patients (22.1%) and 195 patients (14.1%), respectively. Use of androgen deprivation therapy varied substantially among series. Biochemical disease-free survival at 5 years was reported for a cohort of 812 (58.9%) patients. The combined median biochemical disease-free survival for this group of patients was 85% (range: 78.8-100%; 95% confidence interval: 77.1-82.7%). The average occurrence of grade III or worse gastrointestinal and genitourinary late toxicity was, respectively, 2.5% and 3.1% for intensity-modulated RT boost, 10% and 6% for stereotactic body RT, 6% and 2% for low-dose rate BT, and 4% and 4.3% for high-dose rate BT. This review shows encouraging results for focal dose escalation to the IDN with acceptable short- to medium-term side effects and biochemical disease control rates. However, owing to the heterogeneity of patient population and the short follow-up, the results should be interpreted with caution. Considering that the clinical endpoint in the studies was biochemical recurrence, the use and duration of androgen deprivation therapy administration should be carefully considered before driving definitive conclusions. Randomized trials with long-term follow-up are needed before this technique can be generally recommended.
Mots-clé
Boost, Brachytherapy, Dominant intraprostatic lesion, Hypofractionated radiotherapy, Localized prostate cancer, Review, Stereotactic body radiation therapy
Pubmed
Web of science
Open Access
Oui
Création de la notice
08/02/2019 15:40
Dernière modification de la notice
20/08/2019 15:49
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