1. Brachytherapy boost (BT-boost) or stereotactic body radiation therapy boost (SBRT-boost) for high-risk prostate cancer (HR-PCa)
- Author
-
G. Mauriange-Turpin, T. Lizée, Stéphane Supiot, P. Trémolières, Jonathan Khalifa, P. Graff-Cailleaud, S. Krhili, E. Blais, and G. Peyraga
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Stereotactic body radiation therapy ,medicine.medical_treatment ,Brachytherapy ,Radiosurgery ,complex mixtures ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cumulative incidence ,Prospective Studies ,Retrospective Studies ,Clinical Trials as Topic ,business.industry ,Prostatic Neoplasms ,Cancer ,Androgen Antagonists ,Retrospective cohort study ,Gold standard (test) ,medicine.disease ,Combined Modality Therapy ,Radiation therapy ,030220 oncology & carcinogenesis ,Radiation Dose Hypofractionation ,Dose Fractionation, Radiation ,business - Abstract
Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D'Amico classification risk system) with external body radiation therapy (EBRT)+brachytherapy-boost (BT-boost) or with EBRT+stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms "high risk prostate cancer boost". Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT+androgen deprivation treatment (ADT)] versus EBRT+ADT+BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE-EBRT. These recent findings demonstrate the superiority of EBRT+BT-boost+ADT versus DE-EBRT+ADT for HR-PCa. It seems that EBRT+BT-boost+ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa.
- Published
- 2021
- Full Text
- View/download PDF