Dataset Information

The Effectiveness of Intensity Modulated Radiation Therapy versus Three-Dimensional Radiation Therapy in Prostate Cancer: A Meta-Analysis of the Literatures.

ABSTRACT:

Background and purpose

Intensity modulated radiation therapy (IMRT) can deliver higher doses with less damage of healthy tissues compared with three-dimensional radiation therapy (3DCRT). However, for the scenarios with better clinical outcomes for IMRT than 3DCRT in prostate cancer, the results remain ambiguous. We performed a meta-analysis to assess whether IMRT can provide better clinical outcomes in comparison with 3DCRT in patients diagnosed with prostate cancer.

Materials and methods

We conducted a meta-analysis of 23 studies (n = 9556) comparing the clinical outcomes, including gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, biochemical controland overall survival (OS).

Results

IMRT was significantly associated with decreased 2-4 grade acute GI toxicity [risk ratio (RR) = 0.59 (95% confidence interval (CI), 0.44, 0.78)], late GI toxicity [RR = 0.54, 95%CI (0.38, 0.78)], late rectal bleeding [RR = 0.48, 95%CI (0.27, 0.85)], and achieved better biochemical control[RR = 1.17, 95%CI (1.08, 1.27)] in comparison with 3DCRT. IMRT and 3DCRT remain the same in regard of grade 2-4 acute rectal toxicity [RR = 1.03, 95%CI (0.45, 2.36)], late GU toxicity [RR = 1.03, 95%CI (0.82, 1.30)] and overall survival [RR = 1.07, 95%CI (0.96, 1.19)], while IMRT slightly increased the morbidity of grade 2-4 acute GU toxicity [RR = 1.08, 95%CI (1.00, 1.17)].

Conclusions

Although some bias cannot be ignored, IMRT appears to be a better choice for the treatment of prostate cancer when compared with 3DCRT.

SUBMITTER: Yu T

PROVIDER: S-EPMC4865138 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Publications

The Effectiveness of Intensity Modulated Radiation Therapy versus Three-Dimensional Radiation Therapy in Prostate Cancer: A Meta-Analysis of the Literatures.

Yu Ting T Zhang Qiongwen Q Zheng Tianying T Shi Huashan H Liu Yang Y Feng Shijian S Hao Meiqin M Ye Lei L Wu Xueqian X Yang Cheng C

PloS one 20160512 5

<h4>Background and purpose</h4>Intensity modulated radiation therapy (IMRT) can deliver higher doses with less damage of healthy tissues compared with three-dimensional radiation therapy (3DCRT). However, for the scenarios with better clinical outcomes for IMRT than 3DCRT in prostate cancer, the results remain ambiguous. We performed a meta-analysis to assess whether IMRT can provide better clinical outcomes in comparison with 3DCRT in patients diagnosed with prostate cancer.<h4>Materials and me ...[more]

PMID: 27171271

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Project description:PurposeTo give a preliminary report of clinical and treatment factors associated with toxicity in men receiving high-dose radiation therapy (RT) on a phase 3 dose-escalation trial.Methods and materialsThe trial was initiated with 3-dimensional conformal RT (3D-CRT) and amended after 1 year to allow intensity modulated RT (IMRT). Patients treated with 3D-CRT received 55.8 Gy to a planning target volume that included the prostate and seminal vesicles, then 23.4 Gy to prostate only. The IMRT patients were treated to the prostate and proximal seminal vesicles to 79.2 Gy. Common Toxicity Criteria, version 2.0, and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late morbidity scores were used for acute and late effects.ResultsOf 763 patients randomized to the 79.2-Gy arm of Radiation Therapy Oncology Group 0126 protocol, 748 were eligible and evaluable: 491 and 257 were treated with 3D-CRT and IMRT, respectively. For both bladder and rectum, the volumes receiving 65, 70, and 75 Gy were significantly lower with IMRT (all P<.0001). For grade (G) 2+ acute gastrointestinal/genitourinary (GI/GU) toxicity, both univariate and multivariate analyses showed a statistically significant decrease in G2+ acute collective GI/GU toxicity for IMRT. There were no significant differences with 3D-CRT or IMRT for acute or late G2+ or 3+ GU toxicities. Univariate analysis showed a statistically significant decrease in late G2+ GI toxicity for IMRT (P=.039). On multivariate analysis, IMRT showed a 26% reduction in G2+ late GI toxicity (P=.099). Acute G2+ toxicity was associated with late G3+ toxicity (P=.005). With dose-volume histogram data in the multivariate analysis, RT modality was not significant, whereas white race (P=.001) and rectal V70 ≥15% were associated with G2+ rectal toxicity (P=.034).ConclusionsIntensity modulated RT is associated with a significant reduction in acute G2+ GI/GU toxicity. There is a trend for a clinically meaningful reduction in late G2+ GI toxicity with IMRT. The occurrence of acute GI toxicity and large (>15%) volumes of rectum >70 Gy are associated with late rectal toxicity.

Project description:PurposeTo identify predictors of hypothyroidism after chemoradiation therapy for Hodgkin lymphoma (HL) and to compare outcomes after intensity modulated radiation therapy (IMRT) with those after 3-dimensional (3D) conformal radiation therapy (CRT).Methods and materialsNinety patients who underwent involved-site IMRT in 2009 through 2014 were evaluated for treatment-induced hypothyroidism, defined as elevated thyroid-stimulating hormone or decreased free thyroxine levels (or both). Receiver operating characteristic curve analysis identified individuals at low versus high risk based on dosimetric variables. Dosimetric cutoff points were verified with an external data set of 50 patients who underwent 3D-CRT.ResultsIn the IMRT group, most patients (75 [83%]) had stage II HL, and the median prescribed dose was 30.6 Gy; in the 3D-CRT group, 32 patients (64%) had stage II HL, and the median prescribed dose was 32.0 Gy. No differences were found in the proportions of patients with bilateral (P = .982) or unilateral (P = .074) neck involvement between the 2 groups. Hypothyroidism rates were marginally higher in the IMRT group, with estimated 3-year rates of freedom from hypothyroidism of 56.1% in the 3D-CRT group and 40% in the IMRT group (P = .057). Univariate analysis showed that smaller thyroid volume and higher thyroid dose were associated with hypothyroidism in both groups (P < .05). In the IMRT group, the percentage of the thyroid gland volume receiving ≥25 Gy (V25) and the absolute volume of the thyroid gland spared from 25 Gy (VS25Gy) were the strongest predictors of hypothyroidism (P = .001 and P < .001, respectively). Cutoff points of 63.5% (V25) and 2.2 mL (VS25Gy) classified patients as high risk (80%-82%) or low risk (37%-44%) (P < .001). Use of a thyroid avoidance structure reduced the incidence of hypothyroidism (P < .05) in the IMRT group.ConclusionsThe percentage of the thyroid receiving 25 Gy and the volume of the thyroid spared from 25 Gy predicted the risk of hypothyroidism after either IMRT or 3D-CRT for HL. IMRT may confer a higher risk than 3D-CRT unless a treatment avoidance structure is used during planning.

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Dataset Information

The Effectiveness of Intensity Modulated Radiation Therapy versus Three-Dimensional Radiation Therapy in Prostate Cancer: A Meta-Analysis of the Literatures.

Background and purpose

Materials and methods

Results

Conclusions

Publications

The Effectiveness of Intensity Modulated Radiation Therapy versus Three-Dimensional Radiation Therapy in Prostate Cancer: A Meta-Analysis of the Literatures.

Similar Datasets

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