Abstract：
Stereotactic body radiotherapy (SBRT) is gaining wider adoption for prostate cancer management but there remain significant toxicity risks when delivering prostate SBRT with standard techniques. Magnetic resonance-guided daily adaptive SBRT (MRg-A-SBRT) offers technological advantages in precision of radiation dose delivery, but the toxicity profile associated with MRg-A-SBRT compared to more standardly used fiducial or computed tomography-guided non-adaptive prostate SBRT (CT-SBRT) remains unknown.
A meta-analysis to compare acute toxicity rates associated with MRg-A-SBRT and CT-SBRT for prostate cancer was performed in compliance with PRISMA guidelines. MEDLINE (PubMed) and Google Scholar were searched for prospective studies of prostate SBRT that were published between January 1, 2018 and August 31, 2022. Random effects and fixed effects models were used to estimate pooled toxicity rates, and meta-regression was performed to compare toxicity between MRg-A-SBRT and CT-SBRT study groups.
Twenty-nine prospective studies were identified that met the inclusion criteria and included a total of 2547 patients. The pooled estimates for acute grade 2 or higher (G2+) genitourinary (GU) and gastrointestinal (GI) toxicity for MRg-A-SBRT were 16% (95% confidence interval [CI], 10%-24%) and 4% (95% CI, 2%-7%) and for CT-SBRT they were 28% (95% CI, 23%-33%) and 9% (95% CI, 6%-12%), respectively. On meta-regression, the odds ratios for acute G2+ GU and GI toxicities comparing MRg-A-SBRT and CT-SBRT were 0.56 (95% CI, 0.33-0.97, p = .04) and 0.40 (95% CI, 0.17-0.96, p = .04), respectively.
MRg-A-SBRT is associated with a significantly reduced risk of acute G2+ GU or GI toxicity compared to CT-SBRT. Longer follow-up will be needed to evaluate late toxicity and disease control outcomes.
Magnetic resonance imaging-guided daily adaptive prostate stereotactic radiation (MRg-A-SBRT) is a treatment that may allow for delivery of prostate radiation more precisely than other radiotherapy techniques, but it is unknown whether this reduces side effects compared to standardly used computed tomography-guided SBRT (CT-SBRT). In this systematic review and meta-analysis combining data from 29 clinical trials including 2547 patients, it was found that the risk of short-term urinary side effects was reduced by 44% and the risk of short-term bowel side effects was reduced by 60% with MRg-A-SBRT compared to CT-SBRT.
A meta-analysis to compare acute toxicity rates associated with MRg-A-SBRT and CT-SBRT for prostate cancer was performed in compliance with PRISMA guidelines. MEDLINE (PubMed) and Google Scholar were searched for prospective studies of prostate SBRT that were published between January 1, 2018 and August 31, 2022. Random effects and fixed effects models were used to estimate pooled toxicity rates, and meta-regression was performed to compare toxicity between MRg-A-SBRT and CT-SBRT study groups.
Twenty-nine prospective studies were identified that met the inclusion criteria and included a total of 2547 patients. The pooled estimates for acute grade 2 or higher (G2+) genitourinary (GU) and gastrointestinal (GI) toxicity for MRg-A-SBRT were 16% (95% confidence interval [CI], 10%-24%) and 4% (95% CI, 2%-7%) and for CT-SBRT they were 28% (95% CI, 23%-33%) and 9% (95% CI, 6%-12%), respectively. On meta-regression, the odds ratios for acute G2+ GU and GI toxicities comparing MRg-A-SBRT and CT-SBRT were 0.56 (95% CI, 0.33-0.97, p = .04) and 0.40 (95% CI, 0.17-0.96, p = .04), respectively.
MRg-A-SBRT is associated with a significantly reduced risk of acute G2+ GU or GI toxicity compared to CT-SBRT. Longer follow-up will be needed to evaluate late toxicity and disease control outcomes.
Magnetic resonance imaging-guided daily adaptive prostate stereotactic radiation (MRg-A-SBRT) is a treatment that may allow for delivery of prostate radiation more precisely than other radiotherapy techniques, but it is unknown whether this reduces side effects compared to standardly used computed tomography-guided SBRT (CT-SBRT). In this systematic review and meta-analysis combining data from 29 clinical trials including 2547 patients, it was found that the risk of short-term urinary side effects was reduced by 44% and the risk of short-term bowel side effects was reduced by 60% with MRg-A-SBRT compared to CT-SBRT.
摘要：
背景：立体定向放疗（SBRT）在前列腺癌治疗中获得了更广泛的采用，但是当使用标准技术递送前列腺SBRT时，仍然存在显著的毒性风险。磁共振引导的每日自适应SBRT（MRg-A-SBRT）在辐射剂量输送精度方面具有技术优势，但与更标准使用的基准或计算机断层扫描引导的非适应性前列腺SBRT(CT-SBRT)相比,与MRg-A-SBRT相关的毒性特征仍然未知.
方法：根据PRISMA指南进行了一项荟萃分析，以比较MRg-A-SBRT和CT-SBRT对前列腺癌的急性毒性率。搜索了MEDLINE（PubMed）和GoogleScholar，以获取2018年1月1日至2022年8月31日之间发表的前列腺SBRT的前瞻性研究。随机效应和固定效应模型用于估计合并毒性率，使用meta回归分析比较MRg-A-SBRT和CT-SBRT研究组的毒性.
结果：确定了符合纳入标准的29项前瞻性研究，共纳入2547例患者。MRg-A-SBRT的急性2级或更高级别（G2+）泌尿生殖系统（GU）和胃肠道（GI）毒性的汇总估计值为16％（95％置信区间[CI]，10％-24％）和4％（95％CI，2％-7％），CT-SBRT为28％（95％CI，23％-33％）和9％（95％CI，6％-12％），分别。关于元回归，与MRg-A-SBRT和CT-SBRT相比，急性G2+GU和胃肠道毒性的比值比分别为0.56(95%CI，0.33-0.97，p=.04)和0.40(95%CI，0.17-0.96，p=.04)，分别。
结论：与CT-SBRT相比，MRg-A-SBRT与急性G2+GU或胃肠道毒性的风险显著降低相关。需要更长时间的随访来评估晚期毒性和疾病控制结果。
结论：磁共振成像引导的每日适应性前列腺立体定向放射（MRg-A-SBRT）是一种治疗方法，可以比其他放射治疗技术更精确地提供前列腺放射，但与标准使用的计算机断层扫描引导的SBRT（CT-SBRT）相比，这是否可以减少副作用尚不清楚。在这项系统评价和荟萃分析中，结合了29项临床试验的数据，包括2547名患者，结果发现,与CT-SBRT相比,MRg-A-SBRT可将短期泌尿系副作用的风险降低44%,将短期肠道副作用的风险降低60%.
方法：根据PRISMA指南进行了一项荟萃分析，以比较MRg-A-SBRT和CT-SBRT对前列腺癌的急性毒性率。搜索了MEDLINE（PubMed）和GoogleScholar，以获取2018年1月1日至2022年8月31日之间发表的前列腺SBRT的前瞻性研究。随机效应和固定效应模型用于估计合并毒性率，使用meta回归分析比较MRg-A-SBRT和CT-SBRT研究组的毒性.
结果：确定了符合纳入标准的29项前瞻性研究，共纳入2547例患者。MRg-A-SBRT的急性2级或更高级别（G2+）泌尿生殖系统（GU）和胃肠道（GI）毒性的汇总估计值为16％（95％置信区间[CI]，10％-24％）和4％（95％CI，2％-7％），CT-SBRT为28％（95％CI，23％-33％）和9％（95％CI，6％-12％），分别。关于元回归，与MRg-A-SBRT和CT-SBRT相比，急性G2+GU和胃肠道毒性的比值比分别为0.56(95%CI，0.33-0.97，p=.04)和0.40(95%CI，0.17-0.96，p=.04)，分别。
结论：与CT-SBRT相比，MRg-A-SBRT与急性G2+GU或胃肠道毒性的风险显著降低相关。需要更长时间的随访来评估晚期毒性和疾病控制结果。
结论：磁共振成像引导的每日适应性前列腺立体定向放射（MRg-A-SBRT）是一种治疗方法，可以比其他放射治疗技术更精确地提供前列腺放射，但与标准使用的计算机断层扫描引导的SBRT（CT-SBRT）相比，这是否可以减少副作用尚不清楚。在这项系统评价和荟萃分析中，结合了29项临床试验的数据，包括2547名患者，结果发现,与CT-SBRT相比,MRg-A-SBRT可将短期泌尿系副作用的风险降低44%,将短期肠道副作用的风险降低60%.
