Dados do Trabalho

Título

Moderate hypofractionation for salvage radiotherapy (HYPO-SRT) in patients with biochemical recurrence after prostatectomy: a cohort study with meta-analysis.

Introdução

Salvage radiation therapy is the only postoperative curative option for biochemical recurrence for prostate cancer. Although there are clinical trials with safety and efficacy of hypofractionation, the data are limited.

Objetivo

To assess in a cohort study and meta-analysis (MA) the effectiveness and safety of HYPO-SRT in patients with biochemical recurrence after radical prostatectomy.

Método

A cohort study followed by a MA was designed to evaluate bRFS and toxicity with HYPO-SRT for patients with a biochemical recurrence after a radical prostatectomy. Eligible studies were identified on electronic databases through February 2021. We followed the PRISMA and MOOSE guidelines. A meta-regression analysis was performed. A p-value <0.05 was considered significant.

Resultados

A cohort including 43 patients treated by HYPO-SRT was identified. With a median follow-up of 31 months, at 3y the bRFS was 90% (CI95% 70-96%). In the cohort study, the rate of grade 0, 1, 2 and ≥3 late GI and GU toxicity were 64.4%/75.6%,33.3%/20%, 2.2%/4.4% and 0/0, respectively. Combining our cohort with 5 studies a total of 412 patients treated HYPO-SRT were included in the MA. The 3-year bRFS was 73% (CI95% 63 – 83%). The estimation of bRFS at 5 years was 61%. The rate of grade 2 or > late GU and GI toxicity was 6.6% (CI95% 1.2-12), and 3% (CI95%1-5%), with no toxicity grade 3-5. In the meta-regression, % residual PSA, % positive margins, % ADT and % ≥Gleason 8 had a significant association with bRFS (all P<0.05). The late GU toxicity was associated with EQD2 ≥70 Gy (p=0.01).

Conclusão

HYPO-SRT produced satisfactory bRFS with reduced acute/ late GU and GI toxicity rates. The MA analysis supports future studies assessing HYPO SRT.

Palavras-chave

Prostate cancer; salvage radiotherapy; biochemical recurrence; hypofractionation; meta-analysis