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Cochrane Database of Systematic Reviews

Radioterapia coadyuvante posterior a la prostatectomía radical para el cáncer de próstata

Información

DOI:
https://doi.org/10.1002/14651858.CD007234.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 07 diciembre 2011see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Urología

Copyright:
  1. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Autores

  • Tiffany Daly

    Correspondencia a: Mater Centre Radiation Oncology Service, Princess Alexandra Hospital, South Brisbane, Australia

    [email protected]

  • Brigid E Hickey

    Mater Centre Radiation Oncology Service, Princess Alexandra Hospital, South Brisbane, Australia

  • Margot Lehman

    Radiation Oncology Unit, Princess Alexandra Hospital, Brisbane, Australia

  • Daniel P Francis

    Population Health Services, Central Area Health Service, Queensland Health, Stafford DC, Australia

  • Adrienne M See

    Radiation Oncology Services ‐ Mater Centre, Princess Alexandra Hospital, Brisbane, Australia

Contributions of authors

TD wrote the protocol, reviewed results of search and abstracts, extracted and checked data and 'Risk of bias' tables, co‐wrote the discussion and edited review.

BH edited protocol, reviewed results of search and abstracts, extracted and checked data, constructed Risk of bias tables, entered data into RevMan, analysed data, co‐wrote and edited discussion.

ML edited protocol, reviewed results of search and abstracts, edited review.

Sources of support

Internal sources

  • Princess Alexandra Cancer Collaborative Group, Australia.

External sources

  • No sources of support supplied

Declarations of interest

None.

Acknowledgements

Princess Alexandra Cancer Collaborative Group

Version history

Published

Title

Stage

Authors

Version

2011 Dec 07

Adjuvant radiotherapy following radical prostatectomy for prostate cancer

Review

Tiffany Daly, Brigid E Hickey, Margot Lehman, Daniel P Francis, Adrienne M See

https://doi.org/10.1002/14651858.CD007234.pub2

2008 Jul 16

Adjuvant radiotherapy following radical prostatectomy for prostate cancer

Protocol

Tiffany Daly, Brigid E Hickey, Margot Lehman, Daniel P Francis

https://doi.org/10.1002/14651858.CD007234

Differences between protocol and review

We reported risk difference not odds ratio as we proposed to do in the protocol (based on peer reviewer's recommendation).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans; Male;

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 1 Overall survival.
Figuras y tablas -
Analysis 1.1

Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 1 Overall survival.

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Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 2 Metastases.
Figuras y tablas -
Analysis 1.2

Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 2 Metastases.

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Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 3 Local recurrence.
Figuras y tablas -
Analysis 1.3

Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 3 Local recurrence.

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Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 4 Biochemical relapse ITT1.
Figuras y tablas -
Analysis 1.4

Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 4 Biochemical relapse ITT1.

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Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 5 Urethral stricture.
Figuras y tablas -
Analysis 1.5

Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 5 Urethral stricture.

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Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 6 Urinary incontinence.
Figuras y tablas -
Analysis 1.6

Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 6 Urinary incontinence.

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Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 7 Prostate cancer specific survival.
Figuras y tablas -
Analysis 1.7

Comparison 1 Adjuvant RT versus nil postprostatectomy, Outcome 7 Prostate cancer specific survival.

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Table 1. International Incontinence Scale

Grade

Definition

0

dry < 1 gm (gram)

no pads

1

minimal 1 to 9 gm

1 to 4 pads (humid)

2

moderate 10 to 50 gm

1 to 4 pads (soaked)

3

severe > 50 gm

with > 4 pads
Figuras y tablas -
Table 1. International Incontinence Scale
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Table 2. RTOG/EORTC Late RT score Bladder

0

1

2

3

4

Symptom

None

Slight
epithelial
atrophy;
Minor
telangiectasia
(microscopic
hematuria)

Moderate
frequency;
Generalized
telangiectasia;
Intermittent
macroscopic
hematuria

Severe frequency and dysuria;
Severe generalized telangiectasia
(often with petechiae);
Frequent hematuria;
Reduction in bladder capacity
(< 150 cc)

Necrosis/Contracted
bladder
(capacity <100
cc);
Severe
hemorrhagic
cystitis

Figuras y tablas -
Table 2. RTOG/EORTC Late RT score Bladder
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Table 3. HQRL ‐ dichotomous measures

Symptom

Scale

Tenderness and urgency with bowel movements

  1. normal

  2. occasionally mild

  3. frequently mild

  4. mild to moderate

  5. frequent, severe urgency, pain, or bleeding

  6. had to have a colostomy

Urinary frequency

  1. ≤ 4 times/day

  2. 5 to 8 times/day

  3. 9 to 12 times/day

  4. > 12 times/day

  5. indwelling catheter

Erectile dysfunction

  1. normal

  2. weaker

  3. insufficient

  4. unable

Global HQRL: rating of how life is affected by the state of your health

  1. extremely unpleasant

  2. unpleasant

  3. moderately unpleasant

  4. slightly unpleasant

  5. normal (no change)
Figuras y tablas -
Table 3. HQRL ‐ dichotomous measures
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Table 4. Definition of nadir

Study

Definition of nadir

ARO

postoperative PSA < 0.1ng/dL

EORTC

PSA < 0.2 ng/dL

SWOG

PSA ≤ 0.4 ng/dL
Figuras y tablas -
Table 4. Definition of nadir
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Table 5. Number of men who did not nadir

Study

Number of men who did not nadir

ARO

78/388 (20%)

EORTC

108/1005 (10%)

SWOG

127/376 (33%) did not achieve PSA ≤ 0.2 ng/dL

29/376 (7%) of men did not achieve PSA ≤ 0.4ng/dL (which is the definition they used for nadir)

NB: only had PSA information for 376/425 men postoperatively
Figuras y tablas -
Table 5. Number of men who did not nadir
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Table 6. Acute G/U toxicity (RTOG)

Grade

Symptoms

0

No change from baseline

1

urinary frequency and nocturia 2 times pretreatment habit, urgency, no medications

2

frequency, urgency and nocturia, medications required

3

frequency urgency and nocturia with spasms and frequent medications required

4

Haematuria requiring transfusion, acute bladder obstruction ulceration/necrosis

5

Death secondary to radiation side effects
Figuras y tablas -
Table 6. Acute G/U toxicity (RTOG)
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Comparison 1. Adjuvant RT versus nil postprostatectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Overall survival Show forest plot

3

Risk Difference (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Overall survival at 5 years

3

1737

Risk Difference (M‐H, Fixed, 95% CI)

‐0.00 [‐0.03, 0.02]

1.2 Overall survival at 10 years

1

425

Risk Difference (M‐H, Fixed, 95% CI)

‐0.11 [‐0.20, ‐0.02]

2 Metastases Show forest plot

3

Risk Difference (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Metastases at 5 years

3

1737

Risk Difference (M‐H, Fixed, 95% CI)

‐0.01 [‐0.03, 0.01]

2.2 Metastases at 10 years

1

425

Risk Difference (M‐H, Fixed, 95% CI)

‐0.11 [‐0.20, ‐0.01]

3 Local recurrence Show forest plot

2

1379

Risk Difference (M‐H, Fixed, 95% CI)

‐0.11 [‐0.14, ‐0.08]

3.1 Local recurrence at 5 years

1

1005

Risk Difference (M‐H, Fixed, 95% CI)

‐0.10 [‐0.13, ‐0.06]

3.2 Local recurrence at 10 years

1

374

Risk Difference (M‐H, Fixed, 95% CI)

‐0.14 [‐0.21, ‐0.07]

4 Biochemical relapse ITT1 Show forest plot

3

2084

Risk Difference (M‐H, Fixed, 95% CI)

‐0.18 [‐0.22, ‐0.14]

4.1 Biochemical relapse at 5 years

3

1737

Risk Difference (M‐H, Fixed, 95% CI)

‐0.15 [‐0.20, ‐0.11]

4.2 Biochemical relapse at 10 years

1

347

Risk Difference (M‐H, Fixed, 95% CI)

‐0.29 [‐0.39, ‐0.19]

5 Urethral stricture Show forest plot

2

Risk Difference (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Urethral stricture at 5 years

1

307

Risk Difference (M‐H, Fixed, 95% CI)

0.01 [‐0.02, 0.03]

5.2 Urethral stricture at 10 years

1

425

Risk Difference (M‐H, Fixed, 95% CI)

0.08 [0.02, 0.15]

6 Urinary incontinence Show forest plot

2

525

Risk Difference (M‐H, Fixed, 95% CI)

0.04 [0.01, 0.08]

6.1 Urinary incontinence at 5 years

1

100

Risk Difference (M‐H, Fixed, 95% CI)

0.06 [‐0.02, 0.15]

6.2 Urinary incontinence at 10 years

1

425

Risk Difference (M‐H, Fixed, 95% CI)

0.04 [‐0.00, 0.08]

7 Prostate cancer specific survival Show forest plot

1

1005

Risk Difference (M‐H, Fixed, 95% CI)

‐0.01 [‐0.03, 0.00]
Figuras y tablas -
Comparison 1. Adjuvant RT versus nil postprostatectomy
Ir a la tabla de la revisión