PL04 演讲时间：下午 2:15

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.062

Gregory Merrick MD , Martin King MD, PhD , Kent Wallner MD , Robert W. Gallbreath PhD , Ryan Fiano PhD , Wayne M. Butler PhD , Peter F. Orio DO, MS

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引用次数: 0

摘要

目的评估补充性体外放射治疗（EBRT）在预测植入 Pd-103 的高危前列腺癌患者生化治疗失败（BF）和前列腺癌特异性死亡率（PCSM）方面的必要性和/或剂量。44/20 试验将 247 名患者随机分为 44Gy + 90Gy Pd-103 与 20Gy + 115Gy Pd-103 两组。随后进行的 20/0 试验将 383 名患者随机分配到 20Gy 治疗组与单药 125Gy Pd-103 治疗组。近距离放射治疗的处方剂量为前列腺，使用囊外种子，在精囊近端10-12毫米处植入，前列腺周围边缘宽敞。植入后第0天进行基于计算机断层扫描（CT）的剂量测定。生化治疗失败（BF）的定义是PSA在最低点后达到0.40ng/mL。对多个临床、病理和治疗参数进行了评估，以确定其对生化衰竭、PCSM 和总死亡率（OM）的影响。结果在所有 630 例患者中，中位随访时间为 11.8 年，第 0 天 D90 的处方率为 121.9%，V100 的处方率为 98.3%。13 年的 BF、PCSM 和 OM 分别为 5.8%、1.0% 和 30.4%。44/20 例患者（中位随访 13.7 年）的 BF、PCSM 和 OM 分别为 8.9%、2.4% 和 39.7%，而 20/0 例患者（中位随访 10.4 年）的 BF、PCSM 和 OM 分别为 3.6%、0.0% 和 21.5%。两组结果之所以存在差异，部分原因是格里森评分（GS）8-9 患者的数量存在显著差异（15.8% 对 1.6%）。FIR、UIR和HR的BF和PCSM分别为3.5%和0.0%、7.5%和1.9%、15.2%和4.3%。FIR、UIR和HR的中位BF时间分别为5.1年（范围0.7-10.7）、4.6年（范围0.7-12.3）和2.9年（范围0.2-7.8）。增加 EBRT 或剂量都不会影响 BF（图）或 PCSM。在多变量分析中，BF 与植入前 PSA（p=0.019，HR=1.154）、GS（p=0.008，HR=1.748）及& 阳性活检百分比（p=0.015，HR=1.020）关系最为密切。PCSM 与植入前 PSA（p= 0.02，HR=1.218）及 GS（p< 0.001，HR=4.178）关系最为密切。结论在这项研究中，一致、高质量的 Pd-103 剂量分布以及积极的囊外和近端精囊覆盖，为具有较高风险特征的患者带来了持久的生化控制率。补充 EBRT 并不影响 BF 或 PCSM。

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PL04 Presentation Time: 2:15 PM

Purpose

To evaluate the necessity and/or dose of supplemental external beam radiotherapy (EBRT) in predicting biochemical failure (BF) and prostate cancer specific mortality (PCSM) in higher-risk prostate cancer patients implanted with Pd-103.

Materials and Methods

Eligibility criteria included clinically organ-confined disease with Gleason scores 7-9 and/or a pre-treatment prostate-specific antigen (PSA) of 10-20ng/mL. Trial 44/20 randomized 247 patients to 44Gy + 90Gy Pd-103 vs. 20Gy with 115Gy Pd-103. The subsequent 20/0 trial randomized 383 patients to the 20Gy arm vs. monotherapeutic 125Gy Pd-103. The brachytherapy prescription dose was prescribed to the prostate gland with generous periprostatic margins using extracapsular seeds and implantation of the proximal 10-12mm of the seminal vesicles. Post-implant computerized tomography (CT) based dosimetry was performed on day 0. Biochemical failure (BF) was defined as a PSA > 0.40ng/mL after nadir. Multiple clinical, pathologic and treatment parameters were evaluated for impact on BF, PCSM, and overall mortality(OM).

Results

For all 630 patients, the median follow up was 11.8 years with a day 0 D90 of 121.9% of prescription and a V100 of 98.3%. The 13-year BF, PCSM and OM were 5.8%, 1.0%, 30.4%, respectively. For the 44/20 patients (median follow up 13.7 years) BF, PCSM &OM were 8.9%, 2.4% and 39.7% while BF, PCSM & OM for 20/0 (median follow-up 10.4 years) were 3.6%, 0.0% and 21.5%. In part, the difference in outcome between the two groups was due to a significant difference in the number of accrued Gleason score (GS) 8-9 patients (15.8% versus 1.6%). BF and PCSM for FIR, UIR and HR were 3.5% and 0.0%, 7.5% and 1.9%, and 15.2%, and 4.3%, respectively. The median time to BF was 5.1 (range 0.7-10.7), 4.6 (range 0.7-12.3), & 2.9 (range 0.2-7.8) years for FIR, UIR & HR. Neither the addition of EBRT or dose impacted BF (Figure) or PCSM. In multivariate analysis, BF was most closely related to pre-implant PSA (p=0.019, HR=1.154), GS (p=0.008, HR=1.748) & percent positive biopsies (p=0.015, HR=1.020). PCSM was most closely related to pre-implant PSA (p= 0.02, HR=1.218) & GS (p< 0.001, HR=4.178). For all biochemically-controlled patients, the median PSA was< 0.02 ng/ml.

Conclusions

In this study, consistent, high-quality Pd-103 dose distributions with aggressive extra-capsular and proximal seminal vesicle coverage resulted in durable biochemical control rates in patients with higher-risk features. The addition of supplemental EBRT did not impact BF or PCSM.

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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.