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.2024.08.013

Osama Mohamad MD PhD , Adriana Cavazos BS , Chad Tang MD , Henry Mok MD , Comron Hassanzadeh MD , Seungtaek Choi MD , Karen Hoffman MD , Lauren Mayo MD , Quynh-Nhu Nguyen MD , Sean McGuire MD , Shalin Shah MD , Brian Chapin MD , John Davis MD , Paul Corn MD , Rajat Kudchadker Phd , Surendra Prajapati PhD , Teresa Bruno BS , Yusung Kim PhD , Steven Frank MD

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引用次数: 0

Abstract

Purpose

Brachytherapy boost has been shown to improve biochemical control when added to external beam radiotherapy (EBRT) in patients with unfavorable intermediate- and high-risk prostate cancer. We report the safety and early efficacy of using proton therapy (PT) and low-dose-rate (LDR) brachytherapy boost at the University of Texas MD Anderson Cancer Center.

Methods and Materials

A retrospective study was conducted, including all patients with intermediate- or high-risk prostate cancer treated with a combination of PT and LDR boost with or without androgen deprivation therapy (ADT), from 2010 until 2023. Patient, initial disease, and treatment characteristics and toxicity and efficacy outcomes were collected. Biochemical failure (BF) was defined per the Phoenix definition (nadir PSA + 2).

Results

One hundred patients received PT and LDR boost, with median age at diagnosis of 68 (IQR 61-72). Most patients (n=78) were Caucasian, 12 were Black, 5 Asian, 3 Hispanic. Thirty-five patients had NCCN intermediate-risk (4 favorable and 31 unfavorable), 55 had high- and 10 had very high-risk disease. The median PT and LDR doses were 44 CGE (range 40-50.4) and 90 Gy (range 90-110). Pd-103 was used in 96 patients, I-125 in 4 patients, and 91 patients had MRI-assisted radiosurgery (MARS) brachytherapy. ADT was used in 92 patients. Rectal spacer was used in 22 patients. After a median follow-up of 43 months, two patients developed BF for a 5-year biochemical recurrence-free survival of 95%. Of the 2 patients with BF, one patient had a PSA 3.2 at 23 months and unknown disease site recurrence and the second developed lymph node metastasis when PSA was 5.1 at 60 months and is receiving intermittent ADT. No patients developed local recurrence or distant metastasis, and none died of prostate cancer. One patient died of other causes with PSA <0.1 at time of death. One patient has increasing PSA but has not met BF criteria. Median PSA nadir was 0.01 (range 0.0-0.4). All patients (n=30) with at least 4 years of PSA follow-up achieved a nadir PSA of 0.2 or less. Four patients had acute urinary retention. Late grade 2 GU or GI toxicity was found in 11 patients (11%) and 3 patients (3%), respectively. Only one patient had a grade 3 toxicity (urethral stricture requiring dilatation and TURP).

Conclusions

Acknowledging the intermediate follow-up duration, PT and LDR boost with and without ADT can achieve high control rates and low toxicity for prostate cancer patients with unfavorable intermediate and high-risk prostate cancer. MARS has enabled the use of MRI at each step of the quality assurance process.

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PPP05 演讲时间：上午 11:06

摘要：目的近距离放射治疗增强疗法已被证明可改善中高危前列腺癌患者的生化控制。我们报告了德克萨斯大学MD安德森癌症中心使用质子治疗（PT）和低剂量率（LDR）近距离放疗增强疗法的安全性和早期疗效。方法与材料我们开展了一项回顾性研究，包括2010年至2023年期间所有接受或未接受雄激素剥夺疗法（ADT）联合PT和LDR增强疗法治疗的中危或高危前列腺癌患者。研究收集了患者、初始疾病和治疗特征以及毒性和疗效结果。结果 100名患者接受了PT和LDR增强治疗，诊断时的中位年龄为68岁（IQR为61-72岁）。大多数患者（78 人）为白种人，12 人为黑人，5 人为亚裔，3 人为西班牙裔。35例患者为NCCN中危（4例良好，31例不良），55例为高危，10例为极高危。PT 和 LDR 剂量的中位数分别为 44 CGE（范围 40-50.4）和 90 Gy（范围 90-110）。96名患者使用了Pd-103，4名患者使用了I-125，91名患者使用了核磁共振辅助放射手术（MARS）近距离治疗。92名患者使用了ADT。22名患者使用了直肠间隔器。中位随访 43 个月后，2 名患者出现了 BF，5 年无生化复发生存率为 95%。在这 2 名 BF 患者中，一名患者在 23 个月时 PSA 为 3.2，疾病部位复发情况不明；另一名患者在 60 个月时 PSA 为 5.1，出现淋巴结转移，目前正在接受间歇性 ADT 治疗。没有患者出现局部复发或远处转移，也没有患者死于前列腺癌。一名患者死于其他原因，死亡时 PSA 为 0.1。一名患者的 PSA 不断升高，但未达到 BF 标准。中位 PSA 最低值为 0.01（范围为 0.0-0.4）。所有随访 PSA 至少 4 年的患者（30 人）的 PSA 最低值均为 0.2 或更低。四名患者出现急性尿潴留。11名患者（11%）和3名患者（3%）分别出现了晚期2级胃肠道或消化道毒性。只有一名患者出现了3级毒性（尿道狭窄，需要进行扩张术和TURP）。结论尽管随访时间较长，但PT和LDR联合或不联合ADT治疗可使前列腺癌中高危患者获得高控制率和低毒性。MARS 使核磁共振成像在质量保证流程的每个步骤中都得以应用。

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.