Publication:
A systematic review of the efficacy and toxicity of brachytherapy boost combined with external beam radiotherapy for nonmetastatic prostate cancer

dc.contributor.coauthorSlevin, F
dc.contributor.coauthorZattoni, F
dc.contributor.coauthorCheccucci, E
dc.contributor.coauthorCumberbatch, MGK
dc.contributor.coauthorNacchia, A
dc.contributor.coauthorCornford, P
dc.contributor.coauthorBriers, E
dc.contributor.coauthorDe Meerleer, G
dc.contributor.coauthorDe Santis, M
dc.contributor.coauthorEberli, D
dc.contributor.coauthorGandaglia, G
dc.contributor.coauthorGillessen, S
dc.contributor.coauthorGrivas, N
dc.contributor.coauthorLiew, M
dc.contributor.coauthorLinares Espinós, EE
dc.contributor.coauthorOldenburg, J
dc.contributor.coauthorOprea-Lager, DE
dc.contributor.coauthorPloussard, G
dc.contributor.coauthorRouvière, O
dc.contributor.coauthorSchoots, IG
dc.contributor.coauthorSmith, EJ
dc.contributor.coauthorStranne, J
dc.contributor.coauthorSmith, CT
dc.contributor.coauthorVan Den Bergh, RCN
dc.contributor.coauthorVan Oort, IM
dc.contributor.coauthorWiegel, T
dc.contributor.coauthorYuan, CY
dc.contributor.coauthorVan den Broeck, T
dc.contributor.coauthorHenry, AM
dc.contributor.departmentKUH (Koç University Hospital)
dc.contributor.departmentSchool of Medicine
dc.contributor.kuauthorTilki, Derya
dc.contributor.schoolcollegeinstituteKUH (KOÇ UNIVERSITY HOSPITAL)
dc.contributor.schoolcollegeinstituteSCHOOL OF MEDICINE
dc.date.accessioned2024-12-29T09:40:48Z
dc.date.issued2023
dc.description.abstractContext: The optimum use of brachytherapy (BT) combined with external beam radiotherapy (EBRT) for localised/locally advanced prostate cancer (PCa) remains uncertain. Objective: To perform a systematic review to determine the benefits and harms of EBRT-BT. Evidence Acquisition: Ovid MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials databases were systematically searched for studies published between January 1, 2000 and June 7, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies compared low- or high-dose-rate EBRT-BT against EBRT ± androgen deprivation therapy (ADT) and/or radical prostatectomy (RP) ± postoperative radiotherapy (RP ± EBRT). The main outcomes were biochemical progression-free survival (bPFS), severe late genitourinary (GU)/gastrointestinal toxicity, metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS), at/beyond 5 yr. Risk of bias was assessed and confounding assessment was performed. A meta-analysis was performed for randomised controlled trials (RCTs). Evidence Synthesis: Seventy-three studies were included (two RCTs, seven prospective studies, and 64 retrospective studies). Most studies included participants with intermediate-or high-risk PCa. Most studies, including both RCTs, used ADT with EBRT-BT. Generally, EBRT-BT was associated with improved bPFS compared with EBRT, but similar MFS, CSS, and OS. A meta-analysis of the two RCTs showed superior bPFS with EBRT-BT (estimated fixed-effect hazard ratio [HR] 0.54 [95% confidence interval {CI} 0.40-0.72], p < 0.001), with absolute improvements in bPFS at 5-6 yr of 4.9-16%. However, no difference was seen for MFS (HR 0.84 [95% CI 0.53-1.28], p = 0.4) or OS (HR 0.87 [95% CI 0.63-1.19], p = 0.4). Fewer studies examined RP ± EBRT. There is an increased risk of severe late GU toxicity, especially with low-dose-rate EBRT-BT, with some evidence of increased prevalence of severe GU toxicity at 5-6 yr of 6.4-7% across the two RCTs. Conclusions: EBRT-BT can be considered for unfavourable intermediate/high-risk localised/locally advanced PCa in patients with good urinary function, although the strength of this recommendation based on the European Association of Urology guideline methodology is weak given that it is based on improvements in biochemical control. Patient Summary: We found good evidence that radiotherapy combined with brachytherapy keeps prostate cancer controlled for longer, but it could lead to worse urinary side effects than radiotherapy without brachytherapy, and its impact on cancer spread and patient survival is less clear.
dc.description.indexedbyWOS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.issue4
dc.description.publisherscopeInternational
dc.description.sponsoredbyTubitakEuN/A
dc.description.volume7
dc.identifier.doi10.1016/j.euo.2023.11.018
dc.identifier.eissn2588-9311
dc.identifier.quartileQ1
dc.identifier.scopus2-s2.0-85184203653
dc.identifier.urihttps://doi.org/10.1016/j.euo.2023.11.018
dc.identifier.urihttps://hdl.handle.net/20.500.14288/23445
dc.identifier.wos1275657900001
dc.keywordsBrachytherapy
dc.keywordsBrachytherapy boost
dc.keywordsExternal beam radiotherapy
dc.keywordsProstate cancer
dc.language.isoeng
dc.publisherElsevier
dc.relation.ispartofEuropean Urology Oncology
dc.subjectOncology
dc.subjectUrology
dc.subjectNephrology
dc.titleA systematic review of the efficacy and toxicity of brachytherapy boost combined with external beam radiotherapy for nonmetastatic prostate cancer
dc.typeReview
dspace.entity.typePublication
local.contributor.kuauthorTilki, Derya
local.publication.orgunit1SCHOOL OF MEDICINE
local.publication.orgunit1KUH (KOÇ UNIVERSITY HOSPITAL)
local.publication.orgunit2KUH (Koç University Hospital)
local.publication.orgunit2School of Medicine
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