Friday, July 12, 20241:30 PM - 2:45 PM PL01 Presentation Time: 1:30 PM

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.059

Jui Chih Cheng BSc, MD , Juanita Crook MD , Nikitha Moideen MD , Greg Arbour MSc , Felipe Castro Canovas MD , Deidre Batchelar PhD , Cynthesia Araujo PhD , Ross Halperin MD , Michelle Hilts PhD , David Kim MD , David Petrik MD , Jim Rose MD , Francois Bachand MD

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引用次数: 0

Abstract

Purpose

This single-center randomized trial compared health-related QOL for men with unfavorable localized prostate cancer treated with combined pelvic external beam radiation (EBRT) and prostate brachytherapy (BT), randomly selected for either High Dose Rate (HDR) or Low Dose Rate (LDR). We now report the efficacy outcomes.

Materials and Methods

Consenting patients receiving pelvic EBRT (46Gy/23) combined with prostate BT were randomized to either LDR (110Gy) or HDR (15Gy) boost. HDRBT preceded EBRT by one week, while LDRBT followed. Androgen deprivation was used in 76%, beginning with three months neoadjuvant and continued for median 12 months. EBRT delivered 46 Gy/23 fractions using IMRT or VMAT in 68% and 3DcRT in 32%. Image guidance was either daily cone beam CT or implanted fiducials. All patients were followed up at 1-, 3-, and 6-mo, every 6 mo to 3 years, then annually. PSA ≤ 0.2 at 4 years defined cure. Biochemical failure-free survival (bFFS), and overall survival (OS) were calculated by Kaplan Meier methods.

Results

From 01/2014 to 12/2019, a random number generator assigned 191 men (42% IR/ 58% HR): 108 to HDR and 87 to LDR. Median age was 71. Clinical stage was T1c in 15%, T2a/b in 48%, T2c/T3a in 35% and T3b in 2%. 43% had Gleason 8 or 9. Median PSA was 11.6 ng/ml, mean 27.0 ng/ml, max 145 ng/ml. The median follow up was 73 months (43m - 116m). The median PSA nadir was 0.07 in HDR and 0.08 in LDR (p=0.16). The median time to PSA nadir was 13.8 mo in HDR and 14.1 in LDR (p=0.87). At four years, 81% of HDR and 83% of LDR had a PSA ≤ 0.2 (p=0.91). At five years, bFFS (nadir+2) for HDR and LDR were 94% and 90% respectively, and at 8 years 86% and 85% respectively. The 8-year OS for HDR and LDR was 73% and 70%. One patient in each arm had intraprostatic local failure. All failures were identified by imaging (CT, bone scan and/or PET) ± biopsy. 12 failures were distant, 3 regional and 2 combined regional and distant.

Conclusions

Previously reported primary QOL endpoint confirmed faster symptom recovery for HDR patients. In this small, randomized comparison, efficacy analysis shows no difference between LDR and HDR boost in biochemical disease-free survival at 5 and 8 years.

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2024 年 7 月 12 日星期五下午 1:30 - 2:45 PL01 演讲时间：下午 1:30

目的这项单中心随机试验比较了盆腔外照射（EBRT）和前列腺近距离放射治疗（BT）联合治疗的不利局部前列腺癌男性患者的健康相关 QOL，随机选择了高剂量率（HDR）或低剂量率（LDR）。材料与方法同意接受盆腔 EBRT（46Gy/23）联合前列腺近距离放射治疗的患者随机接受 LDR（110Gy）或 HDR（15Gy）增强治疗。HDRBT 比 EBRT 早一周，而 LDRBT 则晚一周。76%的患者使用了雄激素剥夺疗法，从新辅助治疗三个月开始，中位持续12个月。68%的患者使用IMRT或VMAT进行EBRT治疗，32%的患者使用3DcRT治疗，治疗剂量为46 Gy/23次。图像引导采用每日锥形束 CT 或植入靶标。所有患者均在 1 个月、3 个月和 6 个月时接受随访，每 6 个月至 3 年随访一次，然后每年随访一次。4 年后 PSA≤0.2 即为治愈。结果从2014年1月至2019年12月，随机数字生成器分配了191名男性患者（42% IR/ 58% HR）：108人接受HDR治疗，87人接受LDR治疗。中位年龄为 71 岁。临床分期为T1c的占15%，T2a/b的占48%，T2c/T3a的占35%，T3b的占2%。43%的患者的 Gleason 为 8 或 9。PSA中位数为11.6纳克/毫升，平均值为27.0纳克/毫升，最大值为145纳克/毫升。中位随访时间为 73 个月（43 个月 - 116 个月）。HDR 和 LDR 的 PSA 低点中位数分别为 0.07 和 0.08（P=0.16）。HDR患者PSA最低点的中位时间为13.8个月，LDR患者为14.1个月（P=0.87）。四年后，81% 的 HDR 和 83% 的 LDR 患者 PSA ≤ 0.2（P=0.91）。5年时，HDR和LDR的bFFS（nadir+2）分别为94%和90%，8年时分别为86%和85%。HDR和LDR的8年OS分别为73%和70%。每组均有一名患者出现前列腺内局部治疗失败。所有失败均通过影像学（CT、骨扫描和/或 PET）和活组织检查确定。12例失败为远处失败，3例为区域失败，2例为区域和远处联合失败。在这项小型随机比较中，疗效分析表明，LDR 和 HDR 在 5 年和 8 年的生化无病生存率方面没有差异。

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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.