PPP05 Presentation Time: 11:06 AM

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.097

Pradnya Chopade MD, Carlton Johnny MD, Robert Weersink PhD, Alexandra Rink PhD, Bernadeth Lao MSc, Anna Simeonov MSc, Anne Di Tomasso MSc, Heather Ballantyne MSc, Jette Borg PhD, Akbar Beiki-Ardakani PhD, Andrew McPartlin MD, Charles Catton MD, Srinivas Raman FRCPC, Rachel Glicksman FRCPC, Peter Chung MD, Alejandro Berlin MD

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引用次数: 0

Abstract

Purpose

Brachytherapy (BT) boost to the whole-gland (i.e., clinical target volume [CTV]) improves oncological outcomes in prostate cancer patients, albeit with higher likelihood of genitourinary (GU) and gastrointestinal (GI) toxicities. Magnetic resonance (MR) imaging can unveil the gross tumour volume (GTV) with high sensitivity and specificity (i.e., 86% (CI 82-89%) and 99% (CI 98-99%), respectively) in patients with localized disease, which also correlates with the most common area of local recurrence after radiation treatment. To improve the therapeutic index of BT boost, one potential approach is circumscribing it to the MR-depicted GTV (i.e., focal BT boost). Another approach is the use of rectal spacers, which significantly decrease the occurrence of radiation-related toxicities. However, their use is limited in ultrasound-guided BT given their echogenic noise limiting visualization of prostate and catheters. An MR-guided BT setting can converge the benefits of improved soft-tissue resolution and rectal spacers in the absence of device-related imaging artifacts. Herein, we present the results of a prospective study using rectal spacers for MR-guided focal BT boost combined with stereotactic body radiotherapy (SBRT) to the prostate.

Materials and Methods

Patients with localized prostate cancer and visible GTV on MR were enrolled in a prospective study (NCT00913939). All patients underwent insertion of rectal spacer under ultrasound guidance. Subsequently, patients received MR-guided HDR BT boost (15Gy in 1 fraction), followed by SBRT to prostate (33Gy to CTV, 30Gy to PTV, in 5 fractions). The present study reports on the first 73 patients enrolled.

Results

Seventy-three patients are included in this analysis, with a median follow-up of 42 months (IQR 30-57). Most patients (47/73; 64.4%) had Grade Group 2 disease; while 37 (50.7%) and 27 (37%) were respectively categorised as NCCN favourable and unfavourable intermediate-risk, and 9 (12.3%) high-risk disease. Thirty percent of patients received combinatorial ADT for a medial duration of 6 months (IQR 6-20). Median number of BT catheters were 5 (IQR 4-7). Acute Grade 1 GI and GU toxicities were seen in 22 (30.1%) and 66 (90.4%) of patients, respectively. Only one case reported Grade 2 acute GU toxicity (dysuria). Late (i.e., 3-months after treatment) Grade 1 GI and GU toxicities were observed in 4 (5.5%) and 29 (39.7%) cases, respectively. There was a single case of late Grade 2 GU toxicity (haematuria). No incidence of acute or late Grade 3-4 toxicities was observed. Seven (9.6%) biochemical recurrence events were recorded, with an associated BCR-free survival of 83.7% at 5 years. Among those with BCR, 6 cases had recurrence localization by imaging: two local recurrences alone (both intra-prostatic outside the focal boost volume), while four had regional and/or distant recurrences.

Conclusions

MR-guidance allows the incorporation of rectal spacers to the BT treatment paradigm, which together with the use of focal BT boost combined with SBRT renders a favourable therapeutic index for men with localized prostate cancer.

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PPP05 演讲时间：上午 11:06

目的对全腺（即临床靶体积[CTV]）进行近距离放射治疗（BT）可改善前列腺癌患者的肿瘤预后，但泌尿生殖系统（GU）和胃肠道（GI）毒性反应的可能性较高。磁共振成像（MR）可以揭示局部疾病患者的肿瘤总体积（GTV），具有较高的灵敏度和特异性（分别为 86% (CI 82-89%) 和 99% (CI 98-99%)），这也与放疗后最常见的局部复发区域相关。为了提高 BT 增效的治疗指数，一种可能的方法是将其限定在 MR 显示的 GTV 范围内（即局灶 BT 增效）。另一种方法是使用直肠间隔器，它能显著减少放射相关毒性反应的发生。然而，由于其回声噪音限制了前列腺和导管的可视化，因此在超声引导下的 BT 中使用有限。在磁共振引导下进行 BT，可以在没有设备相关成像伪影的情况下，将提高软组织分辨率和直肠间隔器的优势结合起来。在此，我们介绍了一项前瞻性研究的结果，该研究使用直肠间隔器在 MR 引导下对前列腺进行病灶 BT 推注并结合立体定向体放射治疗 (SBRT)。所有患者都在超声引导下接受了直肠间隔器插入术。随后，患者在磁共振引导下接受 HDR BT 增效治疗（15Gy，1 次分量），接着接受前列腺 SBRT 治疗（33Gy，CTV；30Gy，PTV，5 次分量）。本研究报告了首批入组的 73 例患者的情况。结果本分析共纳入 73 例患者，中位随访时间为 42 个月（IQR 30-57）。大多数患者（47/73；64.4%）患有2级疾病；37例（50.7%）和27例（37%）分别被归类为NCCN有利和不利中危疾病，9例（12.3%）为高危疾病。30%的患者接受了联合 ADT 治疗，中位持续时间为 6 个月（IQR 6-20）。BT 导管的中位数为 5 个（IQR 4-7）。分别有 22 例（30.1%）和 66 例（90.4%）患者出现急性 1 级消化道和泌尿系统毒性反应。只有一例报告了 2 级急性 GU 毒性反应（排尿困难）。晚期（即治疗后 3 个月）1 级消化道和泌尿系统毒性分别出现在 4 例（5.5%）和 29 例（39.7%）患者中。有一例晚期 2 级 GU 毒性反应（血尿）。未观察到急性或晚期 3-4 级毒性。共记录到 7 例（9.6%）生化复发事件，5 年无 BCR 存活率为 83.7%。在出现 BCR 的病例中，有 6 例通过成像确定了复发位置：2 例仅为局部复发（均为病灶增量以外的膀胱内复发），4 例为区域和/或远处复发。结论MR 导引允许将直肠间隔器纳入 BT 治疗范例，再加上使用病灶 BT 增量与 SBRT，为男性局部前列腺癌患者提供了有利的治疗指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.