Efficacy and toxicity of external-beam radiation therapy for localised prostate cancer: a network meta-analysis

Background: Many radiation regimens for treating prostate cancer have been used over the years, but which regimen is optimal for localised or locally advanced prostate cancer lacks consensus. We performed a network meta-analysis to identify the optimal radiation regimen. Methods: We systematically reviewed data from 27 randomised controlled trials and could group seven radiation regimens as follows: low- and high-dose radiation therapy (LDRT and HDRT), LDRTþ short- or long-term androgen deprivation therapy (LDRTþ SADT and LDRTþ LADT), HDRTþ SADT, hypofractionated radiotherapy (HFRT), and HFRTþ SADT. The main outcomes were overall mortality (OM), prostate-specific antigen (PSA) failure, cancer-specific mortality, and adverse events. Results: For the network meta-analysis of 27 trials, LDRTþ LADT and LDRTþ SADT were associated with decreased risk of OM as compared with LDRT alone as was LDRTþ LADT compared with HDRT. Apart from HFRT, all other treatments were associated with decreased risk of PSA failure as compared with LDRT. HFRTþ SADT was associated with decreased risk of cancer-specific mortality as compared with HFRT, LDRTþ SADT, HDRT, and LDRT. Conclusions: HFRTþ SADT therapy might be the most efficacious treatment but with worst toxicity for localised or locally advanced prostate cancer, and HDRT showed excellent efficacy but more adverse events. In 2013, prostate cancer was diagnosed in 238 590 Americans, and 29 720 died of the disease (Siegel et al, 2013). Indeed, in 2008