Single-fraction high-dose-rate brachytherapy as monotherapy for localized prostate cancer: long-term follow-up study based on meta-analysis

Objective: Although single-fraction high-dose-rate brachytherapy (SFHDR-BT) for localized prostate cancer has been attempted in clinical trials, there is currently a lack of relevant medical evidence. It is essential to conduct a systematic analysis of the long-term safety and efficacy of SFHDR-BT. Materials and methods: Comprehensive and systematic searches for eligible studies were performed in PubMed, Embase, and the Cochrane Library databases. The primary endpoints included safety and efficacy, represented by toxic effects, biochemical recurrence-free survival (bRFS) and overall survival (OS), respectively. The proportion rates were used as the effect measure for each study and were presented with corresponding 95% confidence intervals (CI). Results: Eight studies met the inclusion criteria for quantitative analysis, including 552 patients. The median follow-up was 71.3 months (60-72.8 months). The estimates of cumulative occurrence for severe gastrointestinal (GI) and genitourinary (GU) toxic effects were 0 and 3% (95% CI 1-5%), respectively. The pooled cumulative incidence of grade ≥ 3 sexual dysfunction occurrence was 4% (95% CI 1-7%). The estimate of long term bRFS was 72% (95% CI 68-76%) and 90% (95% CI 85-95%) for long term OS. Conclusion: In general, SFHDR-BT is well tolerated and associated with suboptimal clinical benefit in patients with localized prostate cancer. High-quality prospective studies of SFHDR-BT are necessary to verify its safety and efficacy.