局限性前列腺癌的大分割放射治疗：美国放射治疗与肿瘤学会临床实践指南。
完整摘要 · 中文译文
目的：本指南为局限性前列腺癌患者使用低分割外照射放疗（EBRT）提供循证建议，包括中度低分割（MHF）和超低分割（UHF）的适应证、合适的剂量分割方案、靶区体积以及治疗计划和实施技术。 方法：美国放射肿瘤学会召集了一个多学科工作组，以解决与局限性前列腺癌低分割EBRT相关的5个关键问题。建议基于系统性文献综述，并使用预定义的基于共识的方法制定，同时对证据质量和推荐强度进行分级。 结果：对于接受EBRT的所有风险组患者，推荐使用中度低分割而非常规分割，这得到高质量随机数据的支持，这些数据表明肿瘤学结局、毒性和生活质量相当，且治疗时间更短，可能减少总体治疗负担。对于选择根治性EBRT的低危和中危疾病患者，超低分割被推荐为标准治疗选择，并可在选定高危疾病患者中考虑使用，最好在临床试验背景下进行。分割方案的选择通常应独立于患者年龄、合并症以及雄激素剥夺治疗的使用，尽管对于基线存在显著泌尿功能障碍的患者，中度低分割可能优于超低分割。证据支持使用现代图像引导的适形治疗。 优化靶区覆盖并最大限度减少毒性的技术。此外还就适当的剂量分割方案提供了指导，包括常用的中分次（MHF）和超低分次（UHF）方案，以及靶区和盆腔淋巴结照射的整合。 结论：低分次体外放疗（EBRT）已成为局限性前列腺癌根治性放疗的主要形式，成熟的随机证据支持其疗效与常规分割相当且治疗负担更轻。正在开展的研究将进一步细化患者选择、UHF在较高风险疾病中的作用，以及先进影像和自适应技术的整合。这些基于证据的建议为局限性前列腺癌低分次EBRT的最佳临床实践提供了指导。
完整摘要 · 英文原文
PURPOSE: This guideline provides evidence-based recommendations on the use of hypofractionated external beam radiation therapy (EBRT) in patients with localized prostate cancer, including indications for moderate hypofractionation (MHF) and ultrahypofractionation (UHF), appropriate dose-fractionation regimens, target volumes, and treatment planning and delivery techniques. METHODS: The American Society for Radiation Oncology convened a multidisciplinary task force to address 5 key questions related to hypofractionated EBRT in localized prostate cancer. Recommendations were based on a systematic literature review and developed using a predefined consensus-based methodology with grading of quality of evidence and strength of recommendation. RESULTS: MHF is recommended over conventional fractionation for patients receiving EBRT across all risk groups, supported by high-quality randomized data demonstrating equivalent oncologic outcomes, toxicity, and quality of life, with shorter treatment duration that may reduce overall treatment burden. UHF is recommended as a standard treatment option for patients with low- and intermediate-risk disease electing for definitive EBRT and may be considered in selected patients with high-risk disease, preferably in the context of clinical trials. Selection of fractionation should generally be independent of patient age, comorbidity, and use of androgen deprivation therapy, although MHF may be preferred over UHF for patients with significant baseline urinary dysfunction. Evidence supports the use of contemporary image-guided, conformal treatment techniques to optimize target coverage and minimize toxicity. Guidance is also provided regarding appropriate dose-fractionation regimens, including commonly used MHF and UHF schedules, as well as target volumes and integration of pelvic nodal irradiation. CONCLUSIONS: Hypofractionated EBRT has become the predominant form of definitive radiation therapy for localized prostate cancer, supported by mature randomized evidence demonstrating comparable outcomes to conventional fractionation and reduced treatment burden. Ongoing studies will further refine patient selection, the role of UHF in higher-risk disease, and integration of advanced imaging and adaptive technologies. These evidence-based recommendations inform best clinical practices in the use of hypofractionated EBRT for localized prostate cancer.