Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Australia.
Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):679-85. doi: 10.1016/j.ijrobp.2012.07.006. Epub 2012 Sep 3.
To evaluate the outcomes of patients treated for intermediate- and high-risk prostate cancer with a single schedule of either external beam radiation therapy (EBRT) and high-dose-rate brachytherapy (HDRB) boost or EBRT alone.
From 2001-2006, 344 patients received EBRT with HDRB boost for definitive treatment of intermediate- or high-risk prostate cancer. The prescribed EBRT dose was 46 Gy in 23 fractions, with a HDR boost of 19.5 Gy in 3 fractions. This cohort was compared to a contemporaneously treated cohort who received EBRT to 74 Gy in 37 fractions, using a matched pair analysis. Three-dimensional conformal EBRT was used. Matching was performed using a propensity score matching technique. High-risk patients constituted 41% of the matched cohorts. Five-year clinical and biochemical outcomes were analyzed.
Initial significant differences in prognostic indicators between the unmatched treatment cohorts were rendered negligible after matching, providing a total of 688 patients. Median biochemical follow-up was 60.5 months. The 5-year freedom from biochemical failure was 79.8% (95% confidence interval [CI], 74.3%-85.0%) and 70.9% (95% CI, 65.4%-76.0%) for the HDRB and EBRT groups, respectively, equating to a hazard ratio of 0.59 (95% CI, 0.43-0.81, P=.0011). Interaction analyses showed no alteration in HDR efficacy when planned androgen deprivation therapy was administered (P=.95), but a strong trend toward reduced efficacy was shown compared to EBRT in high-risk cases (P=.06). Rates of grade 3 urethral stricture were 0.3% (95% CI, 0%-0.9%) and 11.8% (95% CI, 8.1%-16.5%) for EBRT and HDRB, respectively (P<.0001). No differences in clinical outcomes were observed.
This comparison of 2 individual contemporaneously treated HDRB and EBRT approaches showed improved freedom from biochemical progression with the HDR approach. The benefit was more pronounced in intermediate- risk patients but needs to be weighed against an increased risk of urethral toxicity.
评估采用单次外照射放疗（EBRT）和高剂量率近距离放疗（HDRB）加量或单纯 EBRT 治疗中高危前列腺癌患者的治疗结果。
2001 年至 2006 年，344 例中高危前列腺癌患者接受了根治性 EBRT 联合 HDRB 加量治疗。EBRT 处方剂量为 46Gy/23 次，HDRB 加量 19.5Gy/3 次。将该队列与同期接受 EBRT 74Gy/37 次的队列进行比较，采用配对分析。三维适形 EBRT 用于治疗。采用倾向评分匹配技术进行匹配。高危患者占匹配队列的 41%。分析了 5 年的临床和生化结果。
在匹配前，未匹配治疗队列之间的预后指标存在明显差异，但在匹配后这些差异变得可以忽略不计，总共纳入 688 例患者。中位生化随访时间为 60.5 个月。HDRB 和 EBRT 组的 5 年生化无失败率分别为 79.8%（95%置信区间[CI]，74.3%-85.0%）和 70.9%（95% CI，65.4%-76.0%），风险比为 0.59（95% CI，0.43-0.81，P=.0011）。交互分析显示，当计划给予雄激素剥夺治疗时，HDR 的疗效没有改变（P=.95），但与 EBRT 相比，高危病例的疗效呈下降趋势（P=.06）。EBRT 和 HDRB 组的 3 级尿道狭窄发生率分别为 0.3%（95% CI，0%-0.9%）和 11.8%（95% CI，8.1%-16.5%）（P<.0001）。两组的临床结局无差异。
本研究比较了 2 种单独的同期 HDRB 和 EBRT 治疗方法，发现 HDR 方法可提高生化无进展生存率。这种获益在中危患者中更为明显，但需要权衡尿道毒性增加的风险。
