Yang George, Strom Tobin J, Wilder Richard B, Shrinath Kushagra, Mellon Eric A, Fernandez Daniel C, Biagioli Matthew C
Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
Cancer Treatment Centers of America, Newnan, GA 30265, USA.
Int Braz J Urol. 2015 May-Jun;41(3):435-41. doi: 10.1590/S1677-5538.IBJU.2014.0289.
To evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes.
One hundred and two prostate cancer patients with prostate volumes >50 mL (range: 5-29 mL) were treated with high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) to 4,500 cGy in 25 daily fractions between 2009 and 2013. HDR brachytherapy monotherapy doses consisted of two 1,350-1,400 cGy fractions separated by 2-3 weeks, and HDR brachytherapy boost doses consisted of two 950-1,150 cGy fractions separated by 4 weeks. Twelve of 32 (38%) unfavorable intermediate risk, high risk, and very high risk patients received androgen deprivation therapy. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.
Median follow-up was 14 months. Dosimetric goals were achieved in over 90% of cases. Three of 102 (3%) patients developed Grade 2 acute proctitis. No variables were significantly associated with Grade 2 acute proctitis. Seventeen of 102 (17%) patients developed Grade 2 acute urinary retention. American Urological Association (AUA) symptom score was the only variable significantly associated with Grade 2 acute urinary retention (p=0.04). There was no ≥ Grade 3 acute toxicity.
Dosimetric coverage of the prostate and normal tissue sparing were adequate in patients with prostate volumes >50 mL. Higher pre-treatment AUA symptom scores increased the relative risk of Grade 2 acute urinary retention. However, the overall incidence of acute toxicity was acceptable in patients with large prostate volumes.
评估大体积前列腺高剂量率近距离放射治疗的前列腺剂量覆盖、正常组织保护及急性毒性。
2009年至2013年间，102例前列腺体积>50 mL（范围：5 - 29 mL）的前列腺癌患者接受了高剂量率（HDR）近距离放射治疗±调强放射治疗（IMRT），分25次每日剂量给予4500 cGy。HDR近距离放射治疗单一疗法剂量由两个1350 - 1400 cGy分次组成，间隔2 - 3周，HDR近距离放射治疗增敏剂量由两个950 - 1150 cGy分次组成，间隔4周。32例（38%）低危、中危、高危及极高危患者中的12例接受了雄激素剥夺治疗。急性毒性按照不良事件通用术语标准（CTCAE）第4版进行分级。
中位随访时间为14个月。超过90%的病例实现了剂量目标。102例患者中有3例（3%）发生2级急性直肠炎。无变量与2级急性直肠炎显著相关。102例患者中有17例（17%）发生2级急性尿潴留。美国泌尿外科学会（AUA）症状评分是与2级急性尿潴留显著相关的唯一变量（p = 0.04）。无≥3级急性毒性。
前列腺体积>50 mL的患者前列腺剂量覆盖和正常组织保护良好。治疗前较高的AUA症状评分增加了2级急性尿潴留的相对风险。然而，大体积前列腺患者急性毒性的总体发生率是可接受的。
