Local Salvage Therapy Alone for Local Recurrence of Prostate Cancer After Radiotherapy: A Systematic Review and Meta-Analysis.

Background

To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa.

为了确定没有全身治疗的局部治疗对于放射复发性PCa的治疗结果。

data_sources

MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025.

从建库开始至2025年5月，对MEDLINE、Embase、Web of Science核心合集和Google Scholar进行了检索。

No date or language filters were used.

未使用日期或语言过滤器。

Data were analyzed from June to November 2025.

数据分析时间为2025年6月至11月。

study_selection

Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy.

选取了前瞻性及回顾性研究，这些研究调查了在根治性放疗后局部复发的前列腺癌（PCa）中，不伴随全身治疗的局部挽救治疗方案。

Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS).

符合条件的研究提供了无雄激素剥夺治疗生存期（ADT-FS）和/或无转移生存期（MFS）数据。

Authors were contacted for additional data.

作者被联系以获取额外数据。

data_extraction_and_synthesis

This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

本研究已前瞻性注册，并遵循系统评价和荟萃分析报告首选条目（PRISMA）指南。

Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2.

使用非随机研究偏倚风险评估工具第2版评估了偏倚风险。

Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors.

从Kaplan-Meier曲线重建了个别患者数据或从作者处获取。

ADT-FS, MFS, and rates of AEs were pooled in a random-effects models.

ADT-FS、MFS和不良事件发生率在随机效应模型中进行了汇总。

main_outcomes_and_measures

Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions.

主要结果是ADT-FS和MFS，这些结果被建模为汇总的Kaplan-Meier曲线，以及严重或更严重的不良事件（AEs）的发生率，这些结果被建模为比例。

Outcomes were stratified by treatment method.

结果按治疗方法进行了分层。

Results

Thirty-one studies (4525 patients) were identified that assessed salvage high-dose-rate brachytherapy (HDR-BT; 336 patients), low-dose-rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients).

识别出31项研究（共4525名患者），评估了挽救性高剂量率近距离放射治疗（HDR-BT；336名患者）、低剂量率近距离放射治疗（LDR-BT；92名患者）、立体定向体部放射治疗（SBRT；213名患者）、根治性前列腺切除术（sRP；1476名患者）、冷冻治疗（1621名患者）、高强度聚焦超声（HIFU；677名患者）或混合方法（110名患者）。

Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP.

前瞻性研究约占证据的四分之一（1055名患者）；然而，未发现任何关于sRP的研究。

Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively.

综合分析的2年和5年ADT无进展生存率（2887名患者）分别为76.8%和55.2%。

Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively.

综合分析的2年和5年无远处转移生存率（3425名患者）分别为90.4%和75.2%。

Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy.

严重或更严重的不良事件发生率（2308名患者）从低剂量率放疗（LDR-BT）的14%，单纯性前列腺切除术（sRP）的13%，高剂量率放疗（HDR-BT）的5%，高强度聚焦超声（HIFU）的5%，立体定向放疗（SBRT）的4%，到冷冻治疗（cryotherapy）的2%不等。

Risk of bias concerns primarily regarded patient selection.

风险偏倚主要关注患者选择。

Limitations included a lack of randomized clinical trials.

局限性包括缺乏随机临床试验。

conclusions_and_relevance

The findings of this systematic reviewand meta-analysissuggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa.

这项系统评价和荟萃分析的结果表明，在经过精心挑选的局部放射复发性前列腺癌患者中，单一局部治疗具有合理的疗效。

ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years.

在2年时，超过四分之三的患者维持了ADT-free生存期，在5年时，超过一半的患者维持了ADT-free生存期。

Approximately one in ten experience an early metastatic event.

大约十分之一的患者经历了早期转移事件。

Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy.

严重不良反应的发生率是可控的，特别是对于挽救性高剂量率近距离放疗（HDR-BT）、高强度聚焦超声（HIFU）、立体定向放疗（SBRT）和冷冻治疗。