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  3. Whole-pelvic Versus Prostate-only Radiotherapy in Clinically Node-negative High-Risk Localised Prostate Cancer: A Systematic Review and Meta-analysis with Reconstructed Individual-patient Data.

Whole-pelvic Versus Prostate-only Radiotherapy in Clinically Node-negative High-Risk Localised Prostate Cancer: A Systematic Review and Meta-analysis with Reconstructed Individual-patient Data.

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Subiela JD
  • Gomis Sellés E
  • López Campos F
  • Aumatell J
  • González-Padilla DA
  • Balbás ÁG
  • López-Curtis D
  • Vera Barragán V
  • Caño-Velasco J
  • Picola Brau N
  • de Pablos-Rodríguez P
  • Gómez Rivas J
  • San-José Manso L
  • Burgos Revilla FJ
  • Barletta F
  • Alongi F
  • Zamboglou C
  • Nicosia L
  • Shelan M
  • Gajate P
  • Guerrero P
  • Buisan Ò
  • Couñago F

Grupos

Abstract

SEARCH STRATEGY AND SOURCES OF INFORMATION: MEDLINE, Embase and ClinicalTrials.gov were searched from database inception to May 2026 without language restriction, supplemented by hand-searching the proceedings of major oncology and radiation-oncology congress (2020-2026). AIMS: Whether elective whole-pelvic radiotherapy (WPRT) improves outcomes over prostate-only radiotherapy (PORT) in high-risk localised prostate cancer remains an open question. We synthesised all phase 3 randomised trials and added a reconstructed individual-patient-data (IPD) analysis. MATERIALS AND METHODS: We included phase III randomised trials of WPRT versus PORT. Trial-reported hazard ratios (HRs) were pooled using a random-effects meta-analysis, and individual-patient data were reconstructed (Guyot algorithm) and pooled. Outcomes were overall survival, biochemical/progression-free survival, and metastasis-free survival; risk of bias (RoB 2) and certainty (GRADE) were assessed for each outcome. RESULTS: Five trials (5172 patients) were included. WPRT did not improve overall survival (HR, 1.07; 95% confidence interval [CI], 0.94 to 1.21; I(2) = 0%; prediction interval, 0.92 to 1.24; reconstructed-IPD HR, 0.98; 0.80 to 1.20). The apparent benefit in biochemical/progression-free survival (HR, 0.84; 0.54 to 1.29) and metastasis-free survival (HR, 0.92; 0.54 to 1.57) was driven entirely by a single prostate-specific membrane antigen (PSMA)-staged, single-centre trial; excluding it, both became null (0.90; 0.77 to 1.06 and 1.00; 0.70 to 1.43). WPRT modestly increased late grade =2 genitourinary and gastrointestinal events without a meaningful severe-event excess. Certainty was moderate for overall survival and very low for both biochemical/progression-free and metastasis-free survival. CONCLUSION: Current randomised evidence does not demonstrate sufficient benefit to support routine elective pelvic irradiation: WPRT does not improve overall survival, and its apparent benefit in progression-related endpoints is not reproducible across trials. POP-RT identifies a clinically plausible subgroup (patients with very-high nodal-risk who were PSMA-staged) in whom benefit is unproven and requires prospective validation in contemporary randomised trials.

Copyright © 2026 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
0936-6555, 1433-2981

CLINICAL ONCOLOGY  ELSEVIER SCIENCE LONDON

Tipo:
Article
Páginas:
104329-104329
PubMed:
42727425

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Keywords

  • Meta-analysis; PSMA-PET; Pelvic nodal irradiation; Prostate cancer; Radiotherapy; Reconstructed individual-patient data

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