MedWire News: High-dose radiotherapy (HDRT) offers better protection against prostate cancer biochemical recurrence than conventional-dose radiotherapy (CDRT), regardless of risk status, conclude Brazilian scientists.
There continues to be uncertainty over the effectiveness of treatment for localized prostate cancer. While dose escalation for radiotherapy appears to improve outcomes, differing dose relationships among studies have meant that meaningful assessments of survival are problematic.
Gustavo Viani and colleagues from Marilia School of Medicine in São Paulo therefore systematically searched the MEDLINE, EMBASE, and CANCERLIT databases, along with the proceedings of annual meetings, for randomized controlled trials comparing the biochemical control achieved with HDRT and CDRT for localized prostate cancer.
In all, seven studies, involving a total of 2812 prostate cancer patients, met the inclusion criteria. Meta-analysis revealed that HDRT significantly reduced the occurrence of biochemical failure in comparison with CDRT, at 24.8% versus 34.6% (pooled odds ratio [OR]=0.60).
However, the results, published in the International Journal of Radiation Oncology Biology Physics, indicate that HDRT did not reduce overall mortality rates compared with CDRT, at 14.4% versus 14.0% (OR=1.02), and there was no significant impact on prostate cancer-specific mortality, at 4.9% versus 6.1% (OR=0.81).
Compared with CDRT, HDRT was associated with a significantly increased rate of late Grade >2 gastrointestinal toxicity (OR=1.58). There was, however, no effect on late Grade >2 genitourinary toxicity.
Defining low-risk disease as stage 20 ng/ml, and intermediate risk as all other values, the team found that HDRT was associated with improved biochemical control in all risk groups.
“Our meta-analysis of data obtained exclusively from randomized controlled trials provide evidence that HDRT is superior to CDRT in terms of preventing biochemical failure in low-, intermediate-, and high-risk prostate cancer patients regardless of their risk status,” the team concludes.
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