Vargas Carlos E, Martinez Alvaro A, Boike Thomas P, Spencer William, Goldstein Neal, Gustafson Gary S, Krauss Daniel J, Gonzalez José
Radiation Oncology Department, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Int J Radiat Oncol Biol Phys. 2006 Oct 1;66(2):416-23. doi: 10.1016/j.ijrobp.2006.04.045. Epub 2006 Jul 31.
To evaluate outcomes of intermediate- and high-risk prostate cancer patients on a prospective dose-escalation study of pelvic external-beam radiation therapy (EBRT) combined with high-dose-rate (HDR) brachytherapy boost.
From November 1991 to April 2003, 197 patients were treated for intermediate- and high-risk disease features. All patients had prostate-specific antigen>10 ng/ml, Gleason score>or=7, or clinical stage>or=T2b, and all received pelvic EBRT (46 Gy) while receiving either two or three HDR boost treatments. HDR dose fractionation increased progressively and was divided into two dose levels. The mean prostate biologic equivalency dose was 88.2 Gy for the low-dose group and 116.8 Gy for the high-dose group (alpha/beta=1.2). Clinical failure was either local failure or distant metastasis; clinical event-free survival (cEFS) was defined as patients who lived free of clinical failure.
Median follow-up was 4.9 years. The 5-year rates were as follows: biologic failure (BF), 18.6%, clinical failure (CF), 9.8%, cEFS 84.8%, cause-specific survival (CSS), 98.3%, and overall survival (OS), 92.9%. Five-year biochemical failure (68.7% vs. 86%, p<0.001), CF (6.1% vs. 15.6%, p=0.04), cEFS (75.5% vs. 91.7%, p=0.003), CSS (95.4% vs. 100%, p=0.02), and OS (86.2% vs. 97.8%, p=0.002) were significantly better for the high-dose group. Multivariate analysis showed that high-dose group (p=0.01, HR 0.35) and Gleason score (p=0.01, HR 1.84) were significant variables for cEFS. Multivariate analysis showed that high-dose group (p=0.01, HR 0.14) and age (p=0.03, HR 1.09 per year) were significant variables for overall survival.
There is a strong dose-response relationship for intermediate- to high-risk prostate cancer patients. Improved locoregional control with higher radiation doses alone can significantly decrease biochemical and clinical failures.
在一项盆腔外照射放疗（EBRT）联合高剂量率（HDR）近距离放疗增敏的前瞻性剂量递增研究中，评估中高危前列腺癌患者的治疗结果。
1991年11月至2003年4月，197例具有中高危疾病特征的患者接受了治疗。所有患者的前列腺特异性抗原>10 ng/ml、Gleason评分>或=7或临床分期>或=T2b，所有患者在接受两次或三次HDR增敏治疗的同时接受盆腔EBRT（46 Gy）。HDR剂量分割逐渐增加，并分为两个剂量水平。低剂量组前列腺平均生物等效剂量为88.2 Gy，高剂量组为116.8 Gy（α/β=1.2）。临床失败定义为局部失败或远处转移；临床无事件生存期（cEFS）定义为无临床失败的患者。
中位随访时间为4.9年。5年发生率如下：生物失败（BF）为18.6%，临床失败（CF）为9.8%，cEFS为84.8%，病因特异性生存率（CSS）为98.3%，总生存率（OS）为92.9%。高剂量组的5年生化失败（68.7%对86%，p<0.001）、CF（6.1%对15.6%，p=0.04）、cEFS（75.5%对91.7%，p=0.003）、CSS（95.4%对100%，p=0.02）和OS（86.2%对97.8%，p=0.002）均显著更好。多因素分析显示，高剂量组（p=0.01，HR 0.35）和Gleason评分（p=0.01，HR 1.84）是cEFS的显著变量。多因素分析显示，高剂量组（p=0.01，HR 0.14）和年龄（p=0.03，HR每年1.09）是总生存的显著变量。
中高危前列腺癌患者存在强烈的剂量反应关系。仅通过提高放疗剂量改善局部区域控制可显著降低生化和临床失败率。
