Abstract：
OBJECTIVE: This systematic review provides an overview of literature on the impact of MR-guided radiotherapy (MRgRT) on patient reported outcomes (PROs) in patients with prostate cancer (PC).
METHODS: A systematic search was performed in October 2023 in PubMed, EMBASE and Cochrane Library. The PICOS framework (i.e., patient, intervention, comparison, outcome, study design) was used to determine eligibility criteria. Included were studies assessing PROs following MRgRT for PC with sample size >10. Methodological quality was assessed using the ROBINS-I and RoB 2. Relevant mean differences (MD) compared to pre-RT were interpreted using minimal important differences (MID). Meta-analyses were performed using random-effects models. Between-study heterogeneity was assessed using the I2-statistic.
RESULTS: Eleven observational studies and one randomized controlled trial (n=897) were included. Nine studies included patients with primary PC with MRgRT as first-line treatment (n=813) and three with MRgRT as second-line treatment (n=84). Substantial risk of bias was found in five studies. EORTC QLQ-C30 and EORTC QLQ-PR25 scores were pooled from three studies, and EPIC-26 scores from four studies. Relevant MDs for the urinary domain were found with the EPIC-26 (MD-10.0 [95%CI -12.0 - -8.1]; I20%) and the EORTC QLQ-PR25 (MD8.6 [95%CI -4.7-22.0]; I297%), both at end-RT to one month follow-up. Relevant MDs for the bowel domain were found with the EPIC-26 (MD-4.7 [95%CI -9.2 - -0.2]; I282%), at end-RT or one month follow-up, but not with the EORTC QLQ-PR25. For both domains, no relevant MDs were found after three months of follow-up. No relevant MDs were found in the general QoL domains of the EORTC QLQ-C30.
CONCLUSIONS: MRgRT for PC results in a temporarily worsening of patient-reported urinary and bowel symptoms during the first month after treatment compared to pre-RT, resolving at 3 months. No clinically relevant changes were found for general QoL domains. These results provide important information for patient counseling and can serve as a benchmark for future studies.
METHODS: A systematic search was performed in October 2023 in PubMed, EMBASE and Cochrane Library. The PICOS framework (i.e., patient, intervention, comparison, outcome, study design) was used to determine eligibility criteria. Included were studies assessing PROs following MRgRT for PC with sample size >10. Methodological quality was assessed using the ROBINS-I and RoB 2. Relevant mean differences (MD) compared to pre-RT were interpreted using minimal important differences (MID). Meta-analyses were performed using random-effects models. Between-study heterogeneity was assessed using the I2-statistic.
RESULTS: Eleven observational studies and one randomized controlled trial (n=897) were included. Nine studies included patients with primary PC with MRgRT as first-line treatment (n=813) and three with MRgRT as second-line treatment (n=84). Substantial risk of bias was found in five studies. EORTC QLQ-C30 and EORTC QLQ-PR25 scores were pooled from three studies, and EPIC-26 scores from four studies. Relevant MDs for the urinary domain were found with the EPIC-26 (MD-10.0 [95%CI -12.0 - -8.1]; I20%) and the EORTC QLQ-PR25 (MD8.6 [95%CI -4.7-22.0]; I297%), both at end-RT to one month follow-up. Relevant MDs for the bowel domain were found with the EPIC-26 (MD-4.7 [95%CI -9.2 - -0.2]; I282%), at end-RT or one month follow-up, but not with the EORTC QLQ-PR25. For both domains, no relevant MDs were found after three months of follow-up. No relevant MDs were found in the general QoL domains of the EORTC QLQ-C30.
CONCLUSIONS: MRgRT for PC results in a temporarily worsening of patient-reported urinary and bowel symptoms during the first month after treatment compared to pre-RT, resolving at 3 months. No clinically relevant changes were found for general QoL domains. These results provide important information for patient counseling and can serve as a benchmark for future studies.
摘要：
目的：本系统综述了磁共振引导放疗（MRgRT）对前列腺癌（PC）患者报告结局（PRO）影响的文献。
方法：2023年10月在PubMed进行了系统搜索，EMBASE和Cochrane图书馆。PICOS框架(即，病人,干预，比较,结果,研究设计)用于确定合格标准。包括评估样本大小>10的PC的MRgRT后的PRO的研究。使用ROBINS-I和RoB2评估方法学质量。使用最小重要差异(MID)解释与RT前相比的相关平均差异(MD)。采用随机效应模型进行Meta分析。使用I2统计量评估研究之间的异质性。
结果：共纳入11项观察性研究和1项随机对照试验（n=897）。九项研究包括以MRgRT为一线治疗的原发性PC患者（n=813），三项以MRgRT为二线治疗的患者（n=84）。在五项研究中发现了严重的偏倚风险。EORTCQLQ-C30和EORTCQLQ-PR25评分来自三项研究，和4项研究的EPIC-26评分。在EPIC-26（MD-10.0[95CI-12.0--8.1];I20%）和EORTCQLQ-PR25（MD8.6[95CI-4.7-22.0];I297％）中发现了尿结构域的相关MD，两者都在RT结束到一个月的随访。使用EPIC-26发现了肠域的相关MD（MD-4.7[95CI-9.2--0.2]；I282%），在RT结束或一个月随访时，但不是EORTCQLQ-PR25。对于这两个域，随访3个月后未发现相关MD.在EORTCQLQ-C30的一般QoL域中未发现相关MD。
结论：与RT前相比，MRgRT用于PC导致患者报告的泌尿和肠道症状在治疗后的第一个月暂时恶化，在3个月内解决。没有发现一般QoL域的临床相关变化。这些结果为患者咨询提供了重要信息，可以作为未来研究的基准。
方法：2023年10月在PubMed进行了系统搜索，EMBASE和Cochrane图书馆。PICOS框架(即，病人,干预，比较,结果,研究设计)用于确定合格标准。包括评估样本大小>10的PC的MRgRT后的PRO的研究。使用ROBINS-I和RoB2评估方法学质量。使用最小重要差异(MID)解释与RT前相比的相关平均差异(MD)。采用随机效应模型进行Meta分析。使用I2统计量评估研究之间的异质性。
结果：共纳入11项观察性研究和1项随机对照试验（n=897）。九项研究包括以MRgRT为一线治疗的原发性PC患者（n=813），三项以MRgRT为二线治疗的患者（n=84）。在五项研究中发现了严重的偏倚风险。EORTCQLQ-C30和EORTCQLQ-PR25评分来自三项研究，和4项研究的EPIC-26评分。在EPIC-26（MD-10.0[95CI-12.0--8.1];I20%）和EORTCQLQ-PR25（MD8.6[95CI-4.7-22.0];I297％）中发现了尿结构域的相关MD，两者都在RT结束到一个月的随访。使用EPIC-26发现了肠域的相关MD（MD-4.7[95CI-9.2--0.2]；I282%），在RT结束或一个月随访时，但不是EORTCQLQ-PR25。对于这两个域，随访3个月后未发现相关MD.在EORTCQLQ-C30的一般QoL域中未发现相关MD。
结论：与RT前相比，MRgRT用于PC导致患者报告的泌尿和肠道症状在治疗后的第一个月暂时恶化，在3个月内解决。没有发现一般QoL域的临床相关变化。这些结果为患者咨询提供了重要信息，可以作为未来研究的基准。
