Galalae Razvan M, Martinez Alvaro, Nuernberg Nils, Edmundson Gregory, Gustafson Gary, Gonzalez Jose, Kimming Bernhard
Clinic for Radiation Therapy, University Hospital Schleswig Holstein, Campus Kiel, Germany.
Strahlenther Onkol. 2006 Mar;182(3):135-41. doi: 10.1007/s00066-006-1448-5.
To analyze the long-term effect of local dose escalation using conformal hypofractionated high-dose-rate brachytherapy (HDR-BT) boost and pelvic external-beam radiation therapy (EBRT) in hormone-naïve men with localized prostate cancer.
A total of 579 men were consecutively treated with pelvic EBRT and dose escalating HDR-BT since 1986 in two prospective trials: 378 patients at William Beaumont Hospital (1991-2002), and 201 patients at Kiel University (1986-1999). BT optimization was done modulating both, the dwell times and spatial source positions. A short course of neoadjuvant/concurrent androgen deprivation therapy was given to 222 patients. Hormone-naïve patients only (n = 324) with a follow-up > or = 18 months were analyzed. All patients had at least one poor prognostic factor (stage > or = T2b, Gleason Score > or = 7, pretreatment prostate-specific antigen [PSA] > or = 10 ng/ml): any one factor 122 patients, any two factors 122 patients, and three factors 80 patients. This cohort was stratified by equivalent dose (ED): dose level 1, < or = 94 Gy, n = 58, and dose level 2, > 94 Gy, n = 266, assuming an alpha/beta ratio of 1.2. The ASTRO definition for biochemical failure was used.
Mean follow-up was 5.3 years (1.5-13.9 years). For all 324 patients, the 5-year biochemical control (BC) rate was 79%. Cancer-specific survival was 98%, and overall survival 90%. Similar analysis by institution demonstrated no difference in outcomes. For the entire cohort of hormone-naïve men, dose escalation to > 94 Gy resulted in a better 5-year BC of 59% versus 85% (p < 0.001). Discriminating by risk group a striking dose escalation effect was seen in the groups with two or three poor prognostic factors (p = 0.022 and < 0.001, respectively). In the group with only one poor prognostic factor, no statistical difference could be detected questioning the need for ED > 94 Gy.
The results demonstrate that conformal HDR-BT is a successful method for delivering very high radiation dose to the prostate. The ability to escalate dose to ED > 94 Gy was reflected in improved long-term outcomes in terms of BC, significantly for those patients with two or three poor prognostic factors reaching BC rates of 85%.
分析采用适形低分割高剂量率近距离放射治疗（HDR-BT）加量和盆腔外照射放疗（EBRT）对激素初治的局限性前列腺癌男性患者进行局部剂量递增的长期效果。
自1986年起，在两项前瞻性试验中，共有579名男性先后接受了盆腔EBRT和剂量递增的HDR-BT治疗：威廉·博蒙特医院有378例患者（1991 - 2002年），基尔大学有201例患者（1986 - 1999年）。通过调节驻留时间和空间源位置来进行BT优化。222例患者接受了短期新辅助/同步雄激素剥夺治疗。仅对激素初治且随访时间≥18个月的患者（n = 324）进行分析。所有患者至少有一项不良预后因素（分期≥T2b、 Gleason评分≥7、治疗前前列腺特异性抗原[PSA]≥10 ng/ml）：有任何一项因素的患者122例，有任何两项因素的患者122例，有三项因素的患者80例。该队列根据等效剂量（ED）进行分层：剂量水平1，≤94 Gy，n = 58，剂量水平2，＞94 Gy，n = 266，假设α/β比值为1.2。采用美国放射肿瘤学会（ASTRO）关于生化失败的定义。
平均随访时间为5.3年（1.5 - 13.9年）。对于所有324例患者，5年生化控制（BC）率为79%。癌症特异性生存率为98%，总生存率为90%。按机构进行的类似分析显示结果无差异。对于激素初治男性的整个队列，剂量递增至＞94 Gy可使5年BC率从59%提高至85%（p＜0.001）。按风险组区分，在有两项或三项不良预后因素的组中观察到显著的剂量递增效应（分别为p = 0.022和＜0.001）。在仅有一项不良预后因素的组中，未检测到统计学差异，这对ED＞94 Gy的必要性提出了质疑。
结果表明，适形HDR-BT是一种向前列腺输送非常高辐射剂量的成功方法。剂量递增至ED＞94 Gy的能力在BC方面改善了长期结果，对于有两项或三项不良预后因素的患者，BC率显著达到85%。
