A systematic post-QUANTEC review of tolerance doses for prostate cancer radiotherapy
Abstract
Purpose: The aim of this study was to systematically review tolerance doses for late distinct gastrointestinal, genitourinary, and sexual dysfunction (GI/GU/SD) symptoms following external-beam RT (EBRT) alone and treatments involving brachytherapy (BT±EBRT) for prostate cancer post-QUANTEC, and to ultimately perform quantitative syntheses of identified dose/volume tolerances represented by dose-volume histogram (DVH) thresholds, i.e., statistically significant (p≤0.05) cutoff points between symptomatic and asymptomatic patients in a certain study. Methods and Materials: PubMed was scrutinized for full-text articles in English post-QUANTEC (Jan 1st, 2010). Inclusion criteria were randomized controlled/case-control/cohort studies with tolerance doses for late distinct symptoms ≥3 months after primary RT for prostate cancer (N>30). All DVH thresholds were converted into equivalent doses in 2Gy-fractions (EQD2α/β), and were fitted with a linear/linear-quadratic function (goodness-of-fit: R2). The review was registered at PROSPERO (reg.no: CRD42016042464). Results: From 33 identified studies, which included 36–746 patients/symptom domain, the majority of dose/volume tolerances were derived for GI toxicity after EBRT alone (GI/GU/SD: 97/8/1 thresholds). For five symptoms (Defecation urgency, Diarrhea, Fecal incontinence, Proctitis, and Rectal bleeding), relationships between dose/volume tolerances across studies (R2=0.93 (0.82–1.00)), and also across symptoms, leading to a curve…
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