A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER)

Management of locally recurrent prostate cancer after definitive radiotherapy remains controversial due to the perceived high rates of severe genitourinary (GU) and gastrointestinal (GI) toxicity associated with any local salvage modality. To quantitatively compare the efficacy and toxicity of salva...

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Bibliographic Details
Published in:European urology 2021-09, Vol.80 (3), p.280-292
Main Authors: Valle, Luca F., Lehrer, Eric J., Markovic, Daniela, Elashoff, David, Levin-Epstein, Rebecca, Karnes, R. Jeffery, Reiter, Robert E., Rettig, Matthew, Calais, Jeremie, Nickols, Nicholas G., Dess, Robert T., Spratt, Daniel E., Steinberg, Michael L., Nguyen, Paul L., Davis, Brian J., Zaorsky, Nicholas G., Kishan, Amar U.
Format: Article
Language:English
Subjects:
Brachytherapy - adverse effects
Brachytherapy - methods
Cryotherapy
Cryotherapy - adverse effects
High-dose-rate brachytherapy
High-intensity focused ultrasound
High-Intensity Focused Ultrasound Ablation - adverse effects
Humans
Low–dose-rate brachytherapy
Male
Meta-analysis
Neoplasm Recurrence, Local - radiotherapy
Neoplasm Recurrence, Local - therapy
Prospective Studies
Prostate cancer
Prostatectomy - adverse effects
Prostatic Neoplasms - radiotherapy
Prostatic Neoplasms - therapy
Radiation Dosage
Radiation therapy
Radical prostatectomy
Radiorecurrent prostate cancer
Radiosurgery - adverse effects
Salvage therapy
Salvage Therapy - methods
Stereotactic body radiotherapy
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Summary:Management of locally recurrent prostate cancer after definitive radiotherapy remains controversial due to the perceived high rates of severe genitourinary (GU) and gastrointestinal (GI) toxicity associated with any local salvage modality. To quantitatively compare the efficacy and toxicity of salvage radical prostatectomy (RP), high-intensity focused ultrasound (HIFU), cryotherapy, stereotactic body radiotherapy (SBRT), low–dose-rate (LDR) brachytherapy, and high-dose-rate (HDR) brachytherapy. We performed a systematic review of PubMed, EMBASE, and MEDLINE. Two- and 5-yr recurrence-free survival (RFS) rates and crude incidences of severe GU and GI toxicity were extracted as endpoints of interest. Random-effect meta-analyses were conducted to characterize summary effect sizes and quantify heterogeneity. Estimates for each modality were then compared with RP after adjusting for individual study-level covariates using mixed-effect regression models, while allowing for differences in between-study variance across treatment modalities. A total of 150 studies were included for analysis. There was significant heterogeneity between studies within each modality, and covariates differed between modalities, necessitating adjustment. Adjusted 5-yr RFS ranged from 50% after cryotherapy to 60% after HDR brachytherapy and SBRT, with no significant differences between any modality and RP. Severe GU toxicity was significantly lower with all three forms of radiotherapeutic salvage than with RP (adjusted rates of 20% after RP vs 5.6%, 9.6%, and 9.1% after SBRT, HDR brachytherapy, and LDR brachytherapy, respectively; p ≤ 0.001 for all). Severe GI toxicity was significantly lower with HDR salvage than with RP (adjusted rates 1.8% vs 0.0%, p 
ISSN:0302-2838
1873-7560
DOI:10.1016/j.eururo.2020.11.010