高剂量率近距离放射单药治疗高危前列腺癌的三种治疗方案的成熟疗效和毒性结果。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2025-03-01 DOI:10.1016/j.brachy.2024.10.008

Kamran Salari , Hong Ye , Alvaro A. Martinez , Evelyn Sebastian , Amy Limbacher , Kim Marvin , Andrew B. Thompson , Sirisha R. Nandalur , Peter Y. Chen , Daniel J. Krauss

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引用次数: 0

摘要

目的：介绍三种前列腺高剂量率（HDR）近距离放射治疗方案的长期毒性和有效性结果：方法和材料：在前瞻性维护的单一机构数据库中确定了接受 HDR 近距离放射单药治疗的前列腺癌患者。研究对象包括AJCC T分期≤T2b、格里森评分≤7、前列腺特异性抗原水平≤20纳克/毫升且随访时间≥2年的患者：对 671 名患者进行了评估。310名患者接受了4个疗程38 Gy的治疗，129名患者接受了2个疗程24 Gy的治疗，232名患者接受了2个疗程27 Gy的治疗。中位随访时间分别为 12.8 年、10.6 年和 8.1 年（P < 0.001）。231例（74.5%）、92例（71.3%）和81例（34.9%）患者的疾病风险较低（p < 0.001）。急性≥2级GU毒性的发生率分别为11.1%、12.3%和25.0%（P = 0.004），而慢性≥2级GU毒性的发生率分别为17.0%、22.6%和26.5%（P = 0.06）。低危患者的10年总生存率（OS）、无生化失败（ffBF）、局部控制（LC）和无远处转移（ffDM）分别为86.6%、93.3%、97.9%和99.3%。中危患者的10年OS、ffBF、LC和ffDM分别为89.5%、82.6%、90.5%和97.4%。较高的 PSA、较高的 Gleason 评分、神经周围侵犯以及 24 Gy 或 27 Gy 的治疗计划是预测生化失败的因素：结论：与24 Gy/27 Gy 2次分次治疗相比，38 Gy 4次分次的HDR近距离单次治疗可改善长期ffBF，但消化道或泌尿道毒性率并无相关增加。

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Mature effectiveness and toxicity outcomes associated with three treatment schedules of high-dose-rate brachytherapy monotherapy for favorable-risk prostate cancer

Purpose

To present long-term toxicity and effectiveness outcomes of three prostate high-dose-rate (HDR) brachytherapy schedules: 38 Gy in 4 fractions, 24 Gy in 2 fractions, and 27 Gy in 2 fractions for men with low- or intermediate-risk prostate cancer.

Methods and Materials

Patients treated with HDR brachytherapy monotherapy for prostate cancer were identified in a prospectively maintained, single institution database. Patients with AJCC T-stage ≤ T2b, Gleason score ≤ 7, prostate-specific antigen level ≤ 20 ng/mL, and ≥2 years of follow-up were included.

Results

671 patients were evaluated. 310 patients received 38 Gy in 4 fractions, 129 received 24 Gy in 2 fractions, and 232 received 27 Gy in 2 fractions. Median follow-up was 12.8 years, 10.6 years, and 8.1 years (p < 0.001), respectively. 231 (74.5%), 92 (71.3%), and 81 (34.9%) patients (p < 0.001) had low-risk disease. Rates of acute grade ≥2 GU toxicity were 11.1%, 12.3%, and 25.0% (p = 0.004), while chronic grade ≥2 GU toxicity were 17.0%, 22.6%, and 26.5% (p = 0.06). For low-risk patients, 10-year overall survival (OS), freedom from biochemical failure (ffBF), local control (LC), and freedom from distant metastasis (ffDM) were 86.6%, 93.3%, 97.9%, and 99.3%. For intermediate-risk patients, 10-year OS, ffBF, LC, and ffDM were 89.5%, 82.6%, 90.5%, and 97.4%. Higher PSA, higher Gleason score, perineural invasion, and 24 Gy or 27 Gy treatment schedules were predictors of biochemical failure.

Conclusions

HDR brachytherapy monotherapy with 38 Gy in 4 fractions was associated with improved long-term ffBF compared with 24 Gy/27 Gy in 2 fractions, without any associated increase in GI or GU toxicity rates.

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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.