Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D'Amico classification risk system) with external body radiation therapy (EBRT)+brachytherapy-boost (BT-boost) or with EBRT+stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms "high risk prostate cancer boost". Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT+androgen deprivation treatment (ADT)] versus EBRT+ADT+BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE-EBRT. These recent findings demonstrate the superiority of EBRT+BT-boost+ADT versus DE-EBRT+ADT for HR-PCa. It seems that EBRT+BT-boost+ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa.
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique. 2021 Jan 18 [Epub ahead of print]
G Peyraga, T Lizee, J Khalifa, E Blais, G Mauriange-Turpin, S Supiot, S Krhili, P Tremolieres, P Graff-Cailleaud
Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France; Radiation therapy department, Groupe de radiotherapie et d'oncologie des Pyrénées, chemin de l'Ormeau, 65000 Tarbes, France. Electronic address: ., Radiation therapy department, Integrated centre of oncology (Paul Papin), Angers, France., Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France., Radiation therapy department, Groupe de radiotherapie et d'oncologie des Pyrénées, chemin de l'Ormeau, 65000 Tarbes, France., Radiation therapy department, University hospital centre, Limoges, France., Radiation therapy department, Integrated centre of oncology (Rene Gauducheau), Saint-Herblain, France., Radiation therapy department, Curie Institute, Paris, France.