Falk Alexander T, Demontoy Sylvain, Chamorey Emmanuel, Chand Marie-Eve, Gautier Mathieu, Azria David, Zaki Sara, Chevallier Daniel, Cham Kee Daniel Lam, Hannoun-Lévi Jean-Michel
Department of Radiation Oncology, Antoine Lacassagne Center, Nice, France; University of Nice Sophia-Antipolis, Nice, France.
Department of Radiation Oncology, Antoine Lacassagne Center, Nice, France; Department of Radiation Oncology, Montpellier Cancer Institute, Montpellier, France.
Brachytherapy. 2017 Sep-Oct;16(5):993-999. doi: 10.1016/j.brachy.2017.06.013. Epub 2017 Jul 25.
Dose escalation for prostate cancer can be achieved with a combination of external beam radiotherapy (EBRT) and brachytherapy (BT) boost to increase local control. For high-dose-rate (HDR)-BT, optimal fractionation remains under debate. The objective was to assess the clinical outcome of three schemes of HDR-BT boost.
Retrospective single institution data collection was performed. Patients received 46 Gy EBRT then an HDR-BT boost: 3 × 6 Gy, 2 × 9 Gy, or 1 × 14 Gy. HDR needles were placed under general anesthesia with endorectal ultrasonography guidance. CT-scan and treatment were performed postoperatively.
Between 2009 and 2012, 159 patients were included. Nine patients (5.7%) were low, 32 (20.1%) intermediate, and 118 (74.2%) high risk (D'Amico classification) without significant difference between the three BT schemes. With a median followup of 61 months, 5-year biochemical relapse-free survival, 5-year local relapse-free survival, 5-year metastases-free survival, and 5-year overall survival rates were 86.6% (SE 2.7%), 98.3% (SE 1%), 95.3% (SE 1%), and 96.5% (SE 1.5%), respectively, with no significant difference between the BT schemes. The rates of acute ≥ G2 genitourinary and ≥G2 gastrointestinal toxicities were 11.3% and 6.3%, respectively (p = NS). The rates of late genitourinary ≥ G2 and gastrointestinal ≥ G2 toxicities (at last followup) were 9.4% and 0.6% with, respectively, 0.6% and 0% of G4 (p = NS).
Hypofractionation up to a single-fraction HDR-BT boost for prostate cancer yields similar results in terms of biochemical control and late toxicity compared with two or three-fraction schemes. Single fraction HDR-BT appears acceptable for boosting prostate cancer after definitive EBRT.
可通过外照射放疗（EBRT）和近距离放疗（BT）增敏联合应用来实现前列腺癌的剂量递增，以提高局部控制率。对于高剂量率（HDR）-BT，最佳分割方案仍存在争议。本研究目的是评估三种HDR-BT增敏方案的临床疗效。
进行回顾性单机构数据收集。患者先接受46 Gy的EBRT，然后进行HDR-BT增敏：3×6 Gy、2×9 Gy或1×14 Gy。在全身麻醉和直肠内超声引导下放置HDR针。术后进行CT扫描和治疗。
2009年至2012年期间，共纳入159例患者。9例（5.7%）为低危，32例（20.1%）为中危，118例（74.2%）为高危（D'Amico分类），三种BT方案之间无显著差异。中位随访61个月，5年生化无复发生存率、5年局部无复发生存率、5年无转移生存率和5年总生存率分别为86.6%（标准误2.7%）、98.3%（标准误1%）、95.3%（标准误1%）和96.5%（标准误1.5%），三种BT方案之间无显著差异。急性≥2级泌尿生殖系统毒性和≥2级胃肠道毒性发生率分别为11.3%和6.3%（p=无显著性差异）。晚期≥2级泌尿生殖系统毒性和胃肠道≥2级毒性发生率（末次随访时）分别为9.4%和0.6%，4级毒性发生率分别为0.6%和0%（p=无显著性差异）。
与两分割或三分割方案相比，前列腺癌单次大分割HDR-BT增敏在生化控制和晚期毒性方面产生相似的结果。单次分割HDR-BT在确定性EBRT后用于前列腺癌增敏似乎是可接受的。
