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A Systematic Review...
A Systematic Review of the Efficacy and Toxicity of Brachytherapy Boost Combined with External Beam Radiotherapy for Nonmetastatic Prostate Cancer.
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Slevin, Finbar (author)
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Zattoni, Fabio (author)
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Checcucci, Enrico (author)
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Cumberbatch, Marcus G K (author)
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Nacchia, Antonio (author)
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Cornford, Philip (author)
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Briers, Erik (author)
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De Meerleer, Gert (author)
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De Santis, Maria (author)
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Eberli, Daniel (author)
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Gandaglia, Giorgio (author)
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Gillessen, Silke (author)
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Grivas, Nikolaos (author)
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Liew, Matthew (author)
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Linares Espinós, Estefania E (author)
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Oldenburg, Jan (author)
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Oprea-Lager, Daniela E (author)
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Ploussard, Guillaume (author)
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Rouvière, Olivier (author)
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Schoots, Ivo G (author)
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Smith, Emma Jane (author)
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- Stranne, Johan, 1970 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för urologi,Institute of Clinical Sciences, Department of Urology
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Tilki, Derya (author)
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Smith, Catrin Tudur (author)
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Van Den Bergh, Roderick C N (author)
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Van Oort, Inge M (author)
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Wiegel, Thomas (author)
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Yuan, Cathy Y (author)
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Van den Broeck, Thomas (author)
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Henry, Ann M (author)
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(creator_code:org_t)
- 2023
- 2023
- English.
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In: European urology oncology. - 2588-9311.
- Related links:
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
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- The optimum use of brachytherapy (BT) combined with external beam radiotherapy (EBRT) for localised/locally advanced prostate cancer (PCa) remains uncertain.To perform a systematic review to determine the benefits and harms of EBRT-BT.Ovid MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials databases were systematically searched for studies published between January 1, 2000 and June 7, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies compared low- or high-dose-rate EBRT-BT against EBRT±androgen deprivation therapy (ADT) and/or radical prostatectomy (RP)±postoperative radiotherapy (RP±EBRT). The main outcomes were biochemical progression-free survival (bPFS), severe late genitourinary (GU)/gastrointestinal toxicity, metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS), at/beyond 5 yr. Risk of bias was assessed and confounding assessment was performed. A meta-analysis was performed for randomised controlled trials (RCTs).Seventy-three studies were included (two RCTs, seven prospective studies, and 64 retrospective studies). Most studies included participants with intermediate-or high-risk PCa. Most studies, including both RCTs, used ADT with EBRT-BT. Generally, EBRT-BT was associated with improved bPFS compared with EBRT, but similar MFS, CSS, and OS. A meta-analysis of the two RCTs showed superior bPFS with EBRT-BT (estimated fixed-effect hazard ratio [HR] 0.54 [95% confidence interval {CI} 0.40-0.72], p<0.001), with absolute improvements in bPFS at 5-6 yr of 4.9-16%. However, no difference was seen for MFS (HR 0.84 [95% CI 0.53-1.28], p=0.4) or OS (HR 0.87 [95% CI 0.63-1.19], p=0.4). Fewer studies examined RP±EBRT. There is an increased risk of severe late GU toxicity, especially with low-dose-rate EBRT-BT, with some evidence of increased prevalence of severe GU toxicity at 5-6 yr of 6.4-7% across the two RCTs.EBRT-BT can be considered for unfavourable intermediate/high-risk localised/locally advanced PCa in patients with good urinary function, although the strength of this recommendation based on the European Association of Urology guideline methodology is weak given that it is based on improvements in biochemical control.We found good evidence that radiotherapy combined with brachytherapy keeps prostate cancer controlled for longer, but it could lead to worse urinary side effects than radiotherapy without brachytherapy, and its impact on cancer spread and patient survival is less clear.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
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- ref (subject category)
- art (subject category)
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- By the author/editor
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Slevin, Finbar
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Zattoni, Fabio
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Checcucci, Enric ...
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Cumberbatch, Mar ...
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Nacchia, Antonio
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Cornford, Philip
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show more...
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Briers, Erik
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De Meerleer, Ger ...
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De Santis, Maria
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Eberli, Daniel
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Gandaglia, Giorg ...
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Gillessen, Silke
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Grivas, Nikolaos
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Liew, Matthew
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Linares Espinós, ...
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Oldenburg, Jan
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Oprea-Lager, Dan ...
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Ploussard, Guill ...
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Rouvière, Olivie ...
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Schoots, Ivo G
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Smith, Emma Jane
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Stranne, Johan, ...
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Tilki, Derya
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Smith, Catrin Tu ...
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Van Den Bergh, R ...
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Van Oort, Inge M
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Wiegel, Thomas
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Yuan, Cathy Y
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Van den Broeck, ...
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Henry, Ann M
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Urology and Neph ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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European urology ...
- By the university
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University of Gothenburg