In this systematic review and meta-analysis, we describe the oncologic and toxicity outcomes of definitive focal brachytherapy for prostate cancer. A PROSPERO registered study (CRD42023410170) was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, and The Cochrane Library were searched for studies between 2000 and 2022. Two authors independently performed the initial search. Biochemical recurrence-free survival (bRFS) was defined as the primary endpoint for the meta-analysis. Generalized linear mixed-effects models were conducted to calculate effect size and quantify heterogeneity. We also describe the side effects and local recurrence patterns of focal brachytherapy. Ten studies were identified and included 315 patients treated using focal brachytherapy as a definitive treatment. Mean (SD) age was 67.65 (7.9) years and mean (SD) PSA was 7.15 (2.7) ng/mL. Most patients ( = 236, 75%) underwent LDR Brachytherapy and 25% received HDR brachytherapy. Among the participants, 147 (46.5%) had a Gleason score ≤6, and 169 (53.5%) had a Gleason score ≥7. Only 11 (3.5%) patients received ADT. Overall, bRFS rate at median follow-up 4 years (Range: 1–6.42 years) was 91% (95% confidence interval [CI], 82–95%). Acute Grade ≤ 2 GU and GI toxicities were reported in 22 (7%) and 11 (3.5%) patients, respectively. Late Grade ≤ 2 GU and GI toxicity were reported in 6 (2%) and 14 (4.4%) patients, respectively. One case of prostate hemorrhage due to improper foley removal was noted but otherwise no acute or late Grade 3 or higher GI or GU toxicity related to radiotherapy was reported. Overall, definitive focal brachytherapy has a favorable toxicity profile. Oncologic outcomes are yet to mature. The evidence is limited by the small number of studies with low patients’ number, across study heterogeneity, and possibility of publication bias.

中文翻译：

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局部近距离放射治疗作为局限性前列腺癌的最终治疗方法：系统评价和荟萃分析

在这项系统评价和荟萃分析中，我们描述了前列腺癌确定性局部近距离放射治疗的肿瘤学和毒性结果。PROSPERO 注册研究 (CRD42023410170) 是按照系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行的。PubMed、Embase 和 Cochrane 图书馆检索了 2000 年至 2022 年间的研究。两位作者独立进行了初步检索。生化无复发生存期（bRFS）被定义为荟萃分析的主要终点。采用广义线性混合效应模型来计算效应大小并量化异质性。我们还描述了局灶近距离放射治疗的副作用和局部复发模式。已确定 10 项研究，纳入 315 名使用局部近距离放射治疗作为确定性治疗的患者。平均 (SD) 年龄为 67.65 (7.9) 岁，平均 (SD) PSA 为 7.15 (2.7) ng/mL。大多数患者（= 236 例，75%）接受了 LDR 近距离放射治疗，25% 接受了 HDR 近距离放射治疗。参与者中，147 人（46.5%）的格里森评分≤6，169 人（53.5%）的格里森评分≥7。只有 11 名 (3.5%) 患者接受了 ADT。总体而言，中位随访 4 年（范围：1-6.42 年）的 bRFS 率为 91%（95% 置信区间 [CI]，82-95%）。分别有 22 名 (7%) 和 11 名 (3.5%) 患者报告了急性 ≤ 2 级 GU 和胃肠道毒性。分别有 6 名 (2%) 和 14 名 (4.4%) 患者报告了晚期 ≤ 2 级 GU 和胃肠道毒性。注意到一例因 Foley 去除不当导致前列腺出血的病例，但没有报告与放疗相关的急性或晚期 3 级或更高 GI 或 GU 毒性。总体而言，确定性局灶近距离放射治疗具有良好的毒性特征。肿瘤学结果尚未成熟。由于研究数量少、患者数量少、研究间的异质性以及发表偏倚的可能性，证据受到限制。