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Ann Intern Med. 2011 Aug 2;155(3):171-8. doi: 10.7326/0003-4819-155-3-201108020-00347. Epub 2011 Jun 6.

Comparative evaluation of radiation treatments for clinically localized prostate cancer: an updated systematic review.

Author information

1
Institute of Clinical Research and Health Policy Studies, Tufts University School of Medicine, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Boston, Massachusetts 02111, USA.

Abstract

BACKGROUND:

Radiation therapy is one of many treatment options for patients with prostate cancer.

PURPOSE:

To update findings on the clinical and biochemical outcomes of radiation therapies for localized prostate cancer.

DATA SOURCES:

MEDLINE (2007 through March 2011) and the Cochrane Central Register of Controlled Trials (2007 through March 2011).

STUDY SELECTION:

Published English-language comparative studies involving adults with localized prostate cancer who either had first-line radiation therapy or received no initial treatment.

DATA EXTRACTION:

6 researchers extracted information on study design, potential bias, sample characteristics, interventions, and outcomes and rated the strength of overall evidence. Data for each study were extracted by 1 reviewer and confirmed by another.

DATA SYNTHESIS:

75 studies (10 randomized, controlled trials [RCTs] and 65 nonrandomized studies) met the inclusion criteria. No RCTs compared radiation therapy with no treatment or no initial treatment. Among the 10 RCTs, 2 compared combinations of radiation therapies, 7 compared doses and fraction sizes of external-beam radiation therapy (EBRT), and 1 compared forms of low-dose rate radiation therapy. Heterogeneous outcomes were analyzed. Overall, moderate-strength evidence consistently showed that a higher EBRT dose was associated with increased rates of long-term biochemical control compared with lower EBRT dose. The body of evidence was rated as insufficient for all other comparisons.

LIMITATIONS:

Studies inconsistently defined and reported outcomes. Much of the available evidence comes from observational studies with treatment selection biases.

CONCLUSION:

A lack of high-quality comparative evidence precludes conclusions about the efficacy of radiation treatments compared with no treatments for localized prostate cancer.

PRIMARY FUNDING SOURCE:

Agency for Healthcare Research and Quality.

[Indexed for MEDLINE]

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