Comparative evaluation of radiation treatments for clinically localized prostate cancer: an updated systematic review.

Abstract:

BACKGROUND:Radiation therapy is one of many treatment options for patients with prostate cancer. PURPOSE:To update findings on the clinical and biochemical outcomes of radiation therapies for localized prostate cancer. DATA SOURCES:MEDLINE (2007 through March 2011) and the Cochrane Central Register of Controlled Trials (2007 through March 2011). STUDY SELECTION:Published English-language comparative studies involving adults with localized prostate cancer who either had first-line radiation therapy or received no initial treatment. DATA EXTRACTION:6 researchers extracted information on study design, potential bias, sample characteristics, interventions, and outcomes and rated the strength of overall evidence. Data for each study were extracted by 1 reviewer and confirmed by another. DATA SYNTHESIS:75 studies (10 randomized, controlled trials [RCTs] and 65 nonrandomized studies) met the inclusion criteria. No RCTs compared radiation therapy with no treatment or no initial treatment. Among the 10 RCTs, 2 compared combinations of radiation therapies, 7 compared doses and fraction sizes of external-beam radiation therapy (EBRT), and 1 compared forms of low-dose rate radiation therapy. Heterogeneous outcomes were analyzed. Overall, moderate-strength evidence consistently showed that a higher EBRT dose was associated with increased rates of long-term biochemical control compared with lower EBRT dose. The body of evidence was rated as insufficient for all other comparisons. LIMITATIONS:Studies inconsistently defined and reported outcomes. Much of the available evidence comes from observational studies with treatment selection biases. CONCLUSION:A lack of high-quality comparative evidence precludes conclusions about the efficacy of radiation treatments compared with no treatments for localized prostate cancer. PRIMARY FUNDING SOURCE:Agency for Healthcare Research and Quality.

journal_name

Ann Intern Med

authors

Bannuru RR,Dvorak T,Obadan N,Yu WW,Patel K,Chung M,Ip S

doi

10.7326/0003-4819-155-3-201108020-00347

subject

Has Abstract

pub_date

2011-08-02 00:00:00

pages

171-8

issue

3

eissn

0003-4819

issn

1539-3704

pii

0003-4819-155-3-201108020-00347

journal_volume

155

pub_type

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