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. 2023 Sep 11;14(15):2878-2888.
doi: 10.7150/jca.87626. eCollection 2023.

Gastrointestinal/genitourinary adverse event after intensity modulated versus three-dimensional primary radiation therapy in the treatment of prostate cancer: systematic review and meta-analysis

Wei Guo  1 , Yun-Chuan Sun  1 , Li-Yuan Zhang  2 , Xiao-Ming Yin  1
Affiliations

Gastrointestinal/genitourinary adverse event after intensity modulated versus three-dimensional primary radiation therapy in the treatment of prostate cancer: systematic review and meta-analysis

Wei Guo et al. J Cancer. .

Abstract

Objective: Prostate cancer (PCa) is one of the most common cancers in the world. The potential benefits of intensity modulated radiation therapy (IMRT) over three-dimensional conformal radiation therapy (3D-CRT) for PCa primary radiation therapy treatment have not yet been clarified. Therefore, this meta-analysis was conducted to assess whether IMRT could improve clinical outcomes in comparison with 3D-CRT in patients diagnosed with PCa. Materials and methods: Relevant studies were identified through searching related databases till December, 2022. Hazard ratio (HR) or risk ratio (RR) with its corresponding 95% confidence interval (CI) was used as pooled statistics for all analyses. Results: The incidence of grade 2 or worse acute adverse gastrointestinal (GI) event was analyzed and the pooled data revealed a clear decreasing trend in the IMRT compared with 3D-CRT (RR=0.62, 95% CI: 0.45-0.84, p=0.002). IMRT slightly increased the grade ≥ 2 acute genitourinary (GU) adverse event in comparison with the 3D-CRT (RR=1.10, 95% CI: 1.02-1.19, p=0.015). The IMRT and the 3D-CRT of patients showed no substantial differences in grade ≥ 2 late GI adverse event (RR =0.62, 95% CI: 0.36-1.09, p=0.1). In those included studies, there was no significant difference between IMRT and 3D-CRT in grade 2-4 late GU adverse event (RR =1.08, 95% CI: 0.77-1.51, p=0.65). There was a significant difference in biochemical control favoring IMRT (RR =1.13, 95% CI: 1.05-1.22, p=0.002). IMRT showed modest increase in biochemical control in comparison with 3D-CRT. Conclusion: In general, based on the above results, IMRT should be considered as a better choice for the treatment of PCa. More randomized controlled trials are needed to determine the subset of patients diagnosed with PCa.

Keywords: 3D-CRT; Adverse event; Efficacy; IMRT; Prostate cancer.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow chart of the included trials.
Figure 2
Figure 2
Forest plot for acute GI adverse event.
Figure 3
Figure 3
Forest plot for acute GU adverse event.
Figure 4
Figure 4
Forest plot for late GI adverse event.
Figure 5
Figure 5
Forest plot for late GU adverse event.
Figure 6
Figure 6
Forest plot for biochemical control.
Figure 7
Figure 7
Funnel plots evaluating acute GU adverse event.
Figure 8
Figure 8
Sensitivity analysis of the acute GU adverse event.
See this image and copyright information in PMC

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