Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain.
Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain.
Radiother Oncol. 2020 May;146:16-20. doi: 10.1016/j.radonc.2020.01.025. Epub 2020 Feb 18.
To report the pattern of relapse within the prostate with reference to the initial site of disease in patients treated with single fraction 19-Gy.
Forty-four patients were treated according to a prospective study of single-fraction HDR-brachytherapy. Treatment was delivered using 192Ir to a dose of 19 Gy prescribed to the prostate. Patients who experienced a biochemical failure underwent a re-staging multiparametric MRI (mpMRI) and MRI-TRUS fusion biopsy to rule-out local recurrence. In patients with visible Dominant intraprostatic lesions (DIL) on pretreatment mpMRI, the site of local relapse was compared with the initial site of disease. The dose received by the site of recurrence was investigated.
The median follow-up period was 48 months (range 29-63). The PSA nadir was reached at 24 months follow-up, with a median value of 1.07 ng/mL. To date, 14 patients (32%) have experienced biochemical failure (4 patients low-risk and 10 intermediate-risk; p = 0.013). Re-staging mpMRI was performed in 11/14 patients. Eleven patients underwent MRI-TRUS fusion biopsy confirming local relapse in all patients. The analysis of DVH of all 44 patients revealed that patients with biochemical failure had received significantly lower doses in terms of V100, V125 and D90 (p = 0.032, p = 0.018 and p = 0.018 respectively). In patients with DILs on diagnostic mpMRI, the mean D90 and D98 on DIL were lower for patients with biochemical failure.
This dosimetric analysis demonstrates a dose-response relationship in patients treated with single fraction 19 Gy. Patients with intermediate risk disease, with visible DIL on mpMRI and patients treated with cooler implants have higher incidence of biochemical and local failure.
报告在采用单次 19-Gy 剂量治疗的患者中，与初始疾病部位相关的前列腺内复发模式。
44 名患者按照单次 HDR 近距离放疗的前瞻性研究进行治疗。采用 192Ir 给予前列腺 19 Gy 的处方剂量进行治疗。发生生化失败的患者接受重新分期多参数 MRI（mpMRI）和 MRI-TRUS 融合活检，以排除局部复发。在预处理 mpMRI 上可见显性前列腺内病变（DIL）的患者中，比较局部复发部位与初始疾病部位。研究复发部位所接受的剂量。
中位随访时间为 48 个月（范围 29-63）。PSA 最低值在 24 个月随访时达到，中位数为 1.07ng/mL。迄今为止，14 名患者（32%）经历了生化失败（4 名低危和 10 名中危；p=0.013）。14 名患者中的 11 名进行了重新分期 mpMRI。11 名患者接受了 MRI-TRUS 融合活检，所有患者均证实了局部复发。对所有 44 名患者的 DVH 进行分析显示，生化失败患者在 V100、V125 和 D90 方面接受的剂量明显较低（p=0.032、p=0.018 和 p=0.018）。在诊断性 mpMRI 上有 DIL 的患者中，生化失败患者的 DIL 上的 D90 和 D98 的平均值较低。
这项剂量分析表明，在接受单次 19 Gy 剂量治疗的患者中存在剂量反应关系。中危疾病患者、mpMRI 上可见 DIL 且接受较冷植入物治疗的患者，生化和局部失败的发生率更高。
