A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer

R.F. Wolff, S. Ryder, A. Bossi, A. Briganti, J. Crook, A. Henry, J. Karnes, L. Potters, T. de Reijke, N. Stone, M. Burckhardt, S. Duffy, G. Worthy, J. Kleijnen

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)

Abstract

Background: Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken.

Methods: A search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included. Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method.

Results: Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12-1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function. There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified.

Conclusions: Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices. (C) 2015 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)2345-2367
Number of pages23
JournalEuropean Journal of Cancer
Volume51
Issue number16
DOIs
Publication statusPublished - Nov 2015

Keywords

  • Brachytherapy
  • Cryotherapy
  • High-intensity focused
  • ultrasound ablation
  • Prostatic neoplasms
  • Prostatectomy
  • Radiotherapy
  • Review
  • Watchful waiting
  • QUALITY-OF-LIFE
  • EXTERNAL-BEAM RADIOTHERAPY
  • DOSE-ESCALATION TRIAL
  • COMPARING RADICAL PROSTATECTOMY
  • NEOADJUVANT ANDROGEN DEPRIVATION
  • THERAPY ONCOLOGY GROUP
  • 3-DIMENSIONAL CONFORMAL RADIOTHERAPY
  • RADIATION-THERAPY
  • PHASE-III
  • HIGH-RISK

Cite this

Wolff, R.F. ; Ryder, S. ; Bossi, A. ; Briganti, A. ; Crook, J. ; Henry, A. ; Karnes, J. ; Potters, L. ; de Reijke, T. ; Stone, N. ; Burckhardt, M. ; Duffy, S. ; Worthy, G. ; Kleijnen, J. / A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer. In: European Journal of Cancer. 2015 ; Vol. 51, No. 16. pp. 2345-2367.
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abstract = "Background: Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken.Methods: A search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included. Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method.Results: Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95{\%} confidence interval 1.12-1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function. There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified.Conclusions: Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices. (C) 2015 The Authors. Published by Elsevier Ltd.",
keywords = "Brachytherapy, Cryotherapy, High-intensity focused, ultrasound ablation, Prostatic neoplasms, Prostatectomy, Radiotherapy, Review, Watchful waiting, QUALITY-OF-LIFE, EXTERNAL-BEAM RADIOTHERAPY, DOSE-ESCALATION TRIAL, COMPARING RADICAL PROSTATECTOMY, NEOADJUVANT ANDROGEN DEPRIVATION, THERAPY ONCOLOGY GROUP, 3-DIMENSIONAL CONFORMAL RADIOTHERAPY, RADIATION-THERAPY, PHASE-III, HIGH-RISK",
author = "R.F. Wolff and S. Ryder and A. Bossi and A. Briganti and J. Crook and A. Henry and J. Karnes and L. Potters and {de Reijke}, T. and N. Stone and M. Burckhardt and S. Duffy and G. Worthy and J. Kleijnen",
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Wolff, RF, Ryder, S, Bossi, A, Briganti, A, Crook, J, Henry, A, Karnes, J, Potters, L, de Reijke, T, Stone, N, Burckhardt, M, Duffy, S, Worthy, G & Kleijnen, J 2015, 'A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer', European Journal of Cancer, vol. 51, no. 16, pp. 2345-2367. https://doi.org/10.1016/j.ejca.2015.07.019

A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer. / Wolff, R.F.; Ryder, S.; Bossi, A.; Briganti, A.; Crook, J.; Henry, A.; Karnes, J.; Potters, L.; de Reijke, T.; Stone, N.; Burckhardt, M.; Duffy, S.; Worthy, G.; Kleijnen, J.

In: European Journal of Cancer, Vol. 51, No. 16, 11.2015, p. 2345-2367.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer

AU - Wolff, R.F.

AU - Ryder, S.

AU - Bossi, A.

AU - Briganti, A.

AU - Crook, J.

AU - Henry, A.

AU - Karnes, J.

AU - Potters, L.

AU - de Reijke, T.

AU - Stone, N.

AU - Burckhardt, M.

AU - Duffy, S.

AU - Worthy, G.

AU - Kleijnen, J.

PY - 2015/11

Y1 - 2015/11

N2 - Background: Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken.Methods: A search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included. Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method.Results: Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12-1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function. There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified.Conclusions: Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices. (C) 2015 The Authors. Published by Elsevier Ltd.

AB - Background: Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken.Methods: A search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included. Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method.Results: Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12-1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function. There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified.Conclusions: Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices. (C) 2015 The Authors. Published by Elsevier Ltd.

KW - Brachytherapy

KW - Cryotherapy

KW - High-intensity focused

KW - ultrasound ablation

KW - Prostatic neoplasms

KW - Prostatectomy

KW - Radiotherapy

KW - Review

KW - Watchful waiting

KW - QUALITY-OF-LIFE

KW - EXTERNAL-BEAM RADIOTHERAPY

KW - DOSE-ESCALATION TRIAL

KW - COMPARING RADICAL PROSTATECTOMY

KW - NEOADJUVANT ANDROGEN DEPRIVATION

KW - THERAPY ONCOLOGY GROUP

KW - 3-DIMENSIONAL CONFORMAL RADIOTHERAPY

KW - RADIATION-THERAPY

KW - PHASE-III

KW - HIGH-RISK

U2 - 10.1016/j.ejca.2015.07.019

DO - 10.1016/j.ejca.2015.07.019

M3 - Article

VL - 51

SP - 2345

EP - 2367

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

IS - 16

ER -