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The following is a summary of “Patient-reported outcomes following MR-guided radiotherapy for prostate cancer: a systematic review and meta-analysis,” published in the June 2024 issue of Oncology by Westerhoff et al.
This systematic review and meta-analysis aim to comprehensively evaluate the impact of MR-guided radiotherapy (MRgRT) on patient-reported outcomes (PROs) in individuals with prostate cancer (PC).
A systematic search was conducted in October 2023 across PubMed, EMBASE, and the Cochrane Library. Eligibility criteria were determined using the PICOS framework (i.e., patient, intervention, comparison, outcome, study design), including studies with a sample size greater than 10 that assessed PROs following MRgRT for PC. The methodological quality of the included studies was assessed using the ROBINS-I and RoB 2 tools. Compared to pre-radiotherapy, relevant mean differences (MD) were interpreted using minimal important differences (MID). Meta-analyses were performed utilizing random-effects models, and between-study heterogeneity was evaluated using the I2 statistic.
A total of twelve studies were included, consisting of eleven observational studies and one randomized controlled trial, with a combined sample size of 897 patients. Among these, nine studies focused on patients with primary PC receiving MRgRT as a first-line treatment (n=813), while three studies involved MRgRT as a second-line treatment (n=84). Five studies exhibited a substantial risk of bias. The EORTC QLQ-C30 and EORTC QLQ-PR25 scores were pooled from three studies, and EPIC-26 scores from four studies. For the urinary domain, significant mean differences were observed with the EPIC-26 (MD-10.0 [95% CI -12.0 – -8.1]; I2 20%) and the EORTC QLQ-PR25 (MD 8.6 [95% CI -4.7-22.0]; I2 97%), both at the end of radiotherapy to one-month follow-up. For the bowel domain, relevant mean differences were found with the EPIC-26 (MD-4.7 [95% CI -9.2 – -0.2]; I2 82%) at the end of radiotherapy or one-month follow-up, but not with the EORTC QLQ-PR25. No significant mean differences were found after three months of follow-up for both domains. Additionally, no clinically relevant changes were observed in the general quality of life (QoL) domains of the EORTC QLQ-C30.
MRgRT for prostate cancer results in a temporary worsening of patient-reported urinary and bowel symptoms during the first month post-treatment compared to pre-radiotherapy, which resolves in three months. No significant changes were observed in the general QoL domains. These findings are crucial for patient counseling and can serve as a benchmark for future studies, aiding in improving patient care and management strategies.
Source: sciencedirect.com/science/article/pii/S0360301624006916
