Abstract
AbstractBackgroundThere is increasing data on re-irradiation to the prostate using stereotactic body radiotherapy (SBRT) after definite radiotherapy for prostate cancer. There has been increasing evidence on prostate re-irradiation using a C-arm LINAC or a MR LINAC in the last years. We therefore conducted this systematic review and meta-analysis on prostate re-irradiation including studies published from 2020-2023 to serve as an update on existing meta-analysis.MethodsWe searched the Pubmed and Embase databases in October 2023 with queries including combinations of “repeat”, “radiotherapy”, “prostate”, “re-irradiation”, “reirradiation”, “re treatment”, “SBRT”, “retreatment”. Publication date was set to be from 2020 to 2023. There was no limitation regarding language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. After data extraction, heterogeneity testing using I2. Afterwards a random effects model with a restricted maximum likelihood estimator was used for estimating the combined effect. Funnel plot asymmetry was assessed visually and using Eggers test to estimate the presence of publication and/or small study bias.Results14 publications were included in the systematic review. The rates of acute ≥ grade 2 (G2) GU and GI toxicities reported in the included studies range from 0.0-30.0% and 0.0-25.0% respectively. For late ≥G2 GU and GI toxicity, those values are 4.0-51.8% and 0.0-25.0%. The pooled rate of acute GU and GI toxicity ≥G2 were 13% (95% CI: 7-18%) and 2% (95% CI: 0-4%). For late GU and GI toxicity ≥G2 the pooled rates were 25% (95% CI: 14-35%) and 5% (95% CI: 1-9%). The pooled 2-year biochemical recurrence-free survival was 72% (95% CI: 64-92%).ConclusionsSBRT in the re-irradiation of radiorecurrent prostate cancer is overall safe and effective also when applied with a C-arm Linac or an MR Linac. Further prospective data are warranted.
Publisher
Cold Spring Harbor Laboratory