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Hypofractionated Radiation Therapy for Localized Prostate Cancer Guideline statements Statement KQ1A: In men with low-risk prostate cancer who decline active surveillance and receive EBRT to the prostate with or without radiation to the seminal vesicles, moderate hypofractionation should be offered. 声明KQ1A：对于低危前列腺癌患者，如果他们拒绝积极监测，并接受伴或不伴精囊EBRT（前列腺癌根治性外放疗），推荐中等大分割放疗。 Statement KQ1B: In men with intermediate-risk prostate cancer receiving EBRT to the prostate with or without radiation to the seminal vesicles, moderate hypofractionation should be offered. 声明KQ1B：对于中危前列腺癌患者，在接受伴或不伴精囊EBRT（前列腺癌根治性外放疗）时，推荐中等大分割放疗。 Statement KQ1C: In men with high-risk prostate cancer receiving EBRT to the prostate, but not including pelvic lymph nodes, moderate hypofractionation should be offered. 声明KQ1C：对于高危前列腺癌患者，在接受前列腺EBRT治疗时，但不包括盆腔淋巴结照射，推荐中等大分割放疗。 Statement KQ1D: In patients who are candidates for EBRT, moderate hypofractionation should be offered regardless of patient age, comorbidity, anatomy, or urinary function. However, physicians should discuss the limited follow-up beyond five years for most existing RCTs evaluating moderate hypofractionation. 声明KQ1D：对于适合接受前列腺EBRT治疗的患者，无论患者的年龄、合并症、解剖特征或泌尿功能，均应该推荐中等大分割放疗。同时，医生应告知患者目前大多数评估中等大分割放疗的RCT研究5年后的随访数据有限。 Statement KQ1E: Men should be counseled about the small increased risk of acute gastrointestinal (GI) toxicity with moderate hypofractionation. Moderately hypofractionated EBRT has a similar risk of acute and late genitourinary (GU) and late GI toxicity compared to conventionally fractionated EBRT. However, physicians should discuss the limited follow-up beyond five years for most existing RCTs evaluating moderate hypofractionation. 声明KQ1E：（医生）应告知患者中等大分割放疗存在急性胃肠道(GI)毒性略微增加的风险，但中等大分割EBRT的急性及远期泌尿系统毒性反应和慢性胃肠道毒性反应的风险与常规EBRT相似。同时应告知患者目前大多数评估中等大分割放疗的RCT研究大于5年的随访数据有限。 Statement KQ2A: Regimens of 6000 cGy delivered in 20 fractions of 300 cGy and 7000 cGy delivered in 28 fractions of 250 cGy are suggested since they are supported by the largest evidentiary base. One optimal regimen cannot be determined since most of the multiple fractionation schemes evaluated in clinical trials have not been compared head to head. 声明KQ2A：由最大的证据基础支持推荐建议中等大分割放疗方案采用6000cGy/300cGy/20fx，或7000cGy/250cGy/28fx。因大多数临床试验中多个计划靶区无法一一匹配进行比较，因此无法确定一个最佳方案。 Statement KQ2B: One moderately hypofractionated regimen is not suggested over another for cancer control for specific risk groups and the efficacy of moderately hypofractionated EBRT regimens does not appear to be impacted by patient age, comorbidity, anatomy, or urinary function. 声明KQ2B：两种方案在特定风险组的癌症控制率上并没有显示出哪个更优，且中等大分割EBRT方案的疗效并不受患者年龄、合并症、解剖学特征或泌尿系功能的影响。 Statement KQ3A: In men with low-risk prostate cancer who decline active surveillance and choose active treatment with EBRT, ultrahypofractionation may be offered as an alternative to conventional fractionation. 声明KQ3A：对于拒绝积极监测并选择EBRT积极治疗的低危前列腺癌患者，可推荐超大分割放疗代替常规放疗。 Statement KQ3B: In men with intermediate-risk prostate cancer receiving EBRT, ultrahypofractionation may be offered as an alternative to conventional fractionation. The task force strongly encourages that these patients be treated as part of a clinical trial or multi-institutional registry. 声明KQ3B：在接受EBRT治疗的中危前列腺癌患者中，超大分割放疗可作为常规放疗的替代选择。专家组强烈建议将这些患者纳入临床试验或多中心注册研究。 Statement KQ3C: In men with high-risk prostate cancer receiving EBRT, the task force does not suggest offering ultrahypofractionation outside of a clinical trial or multi-institutional registry due to insufficient comparative evidence. 声明KQ3C：在接受EBRT治疗的高危前列腺癌患者中，由于没有足够的比较证据，专家组不建议将超大分割放疗用于临床试验或多中心注册研究之外。 Statement KQ4A: Ultrahypofractionated prostate EBRT of 3500 to 3625 cGy in 5 fractions of 700 to 725 cGy to the planning target volume may be offered to low- and intermediate-risk patients with prostate sizes less than 100 cm3. The key dose constraints in KQ5B should be followed. 声明KQ4A：对于前列腺体积<100cm3的中低危前列腺癌患者，推荐剂量为3500cGy（700cGy/5f）或3625cGy（725cGy/5f）。关键剂量限制应遵循KQ5B中的规定。 Statement KQ4B: Five-fraction prostate ultrahypofractionation at doses above 3625 cGy to the planning target volume is not suggested outside the setting of a clinical trial or multi-institutional registry due to risk of late toxicity. 声明KQ4B：由于存在迟发毒性风险，不推荐将超过3625cGy（5f）的超大分割放疗用于临床试验以外。 Statement KQ4C: Five-fraction prostate ultrahypofractionation using consecutive daily treatments is not suggested due to potential increased risk of late urinary and rectal toxicity. 声明KQ4C：因为存在增加远期泌尿系和结肠毒性的潜在风险，不推荐连续五次超大分割放疗时每日放疗。 Statement KQ5A: At least two dose-volume constraint points for rectum and bladder should be used for moderately or ultrahypofractionated EBRT: one at the high-dose end (near the total dose prescribed) and one in the mid-dose range (near the midpoint of the total dose). 声明KQ5A：局限性前列腺癌患者行大分割EBRT时，直肠和膀胱至少使用2个剂量体积限制点：一个在高剂量端(接近规定的总剂量)，一个在中等剂量范围(接近总剂量的中点)。 Statement KQ5B: Use of normal tissue constraints for moderately or ultrahypofractionated EBRT that differ from those of a published reference study is not recommended due to the risk of both acute and late toxicity. 声明KQ5B：由于急性和晚期毒性的风险，在进行中等或超大分割放疗时，不推荐使用已发表参考研究以外的剂量限制。 Statement KQ6A: Use of target volume and associated margin definitions for hypofractionated EBRT that deviate from those of a published reference study is not recommended, especially for ultrahypofractionated regimens. 声明KQ6A：局限性前列腺癌患者行大分割放疗时，对靶区及外放边界的确定，不建议脱离已发表文献之外的数据，尤其是超大分割放疗。 Statement KQ7A: IGRT is universally recommended when delivering moderately or ultrahypofractionated EBRT. 声明KQ7A：在使用中等或超大分割前列腺EBRT时，普遍推荐IGRT（影像引导放疗技术）。 Statement KQ8A: Non-modulated 3-D CRT techniques are not recommended when delivering moderately or ultrahypofractionated prostate EBRT. 声明KQ8A：在使用中等或超大分割前列腺EBRT时，不推荐使用非调强的三维适形放疗技术。 |
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