A systematic review of randomised controlled trials of radiotherapy for XXXX .

@entity1 @entity263 @entity66 @entity5 @entity344 @entity34
BACKGROUND: @entity263 is the second most frequently diagnosed @entity5 and the sixth leading cause of @entity5 death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for @entity263 was undertaken. METHODS: A search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant @entity34 ( @entity34 ), were included. Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method. RESULTS: Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of @entity263 . While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. @entity344 . Combining EBRT with @entity34 shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12-1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding @entity1 satisfaction and sexual function. There might be advantages of EBRT (with/without @entity34 ) compared to cryoablation (with/without @entity34 ). No studies on HIFU were identified. CONCLUSIONS: Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for @entity66 with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in @entity263 risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices.
