Oakland University William Beaumont School of Medicine, Royal Oak, USA.
21st Century Oncology, Farmington Hills, USA.
Radiother Oncol. 2020 Jun;147:123-129. doi: 10.1016/j.radonc.2020.03.033. Epub 2020 Mar 31.
Using a prospectively collected institutional database, we compared rectal toxicity following high dose rate (HDR) brachytherapy as monotherapy relative to dose-escalated external beam radiotherapy (EBRT) for patients with localized prostate cancer.
2683 patients treated with HDR or EBRT between 1994 and 2017 were included. HDR fractionation was 38 Gy/4 fractions (n = 321), 24 Gy/2 (n = 96), or 27 Gy/2 (n = 128). EBRT patients received a median dose of 75.6 Gy in 1.8 Gy fractions [range 70.2-82.8 Gy], using either 3D conformal or intensity modulated radiotherapy (IMRT). EBRT patients underwent 3D image guidance via an off-line adaptive process.
Median follow-up was 7.5 years (7.4 years for EBRT and 7.9 years for HDR). 545 patients (20.3%) received HDR brachytherapy and 2138 (79.7%) EBRT. 69.1% of EBRT patients received IMRT. Compared to EBRT, HDR was associated with decreased rates of acute grade ≥2 diarrhea (0.7% vs. 4.5%, p < 0.001), rectal pain/tenesmus (0.6% vs. 7.9%, p < 0.001), and rectal bleeding (0% vs. 1.6%, p = 0.001). Rates of chronic grade ≥2 rectal bleeding (1.3% vs. 8.7%, p < 0.001) and radiation proctitis (0.9% vs. 3.3%, p = 0.001) favored HDR over EBRT. Rates of any chronic rectal toxicity grade ≥2 were 2.4% vs. 10.5% (p < 0.001) for HDR versus EBRT, respectively. In those treated with IMRT, acute and chronic rates of any grade ≥2 GI toxicity were significantly reduced but remained significantly greater than those treated with HDR.
In appropriately selected patients with localized prostate cancer undergoing radiation therapy, HDR brachytherapy as monotherapy is an effective strategy for reducing rectal toxicity.
我们使用前瞻性收集的机构数据库，比较了局部前列腺癌患者接受高剂量率（HDR）近距离治疗作为单一疗法与剂量递增外照射放疗（EBRT）的直肠毒性。
纳入 1994 年至 2017 年间接受 HDR 或 EBRT 治疗的 2683 例患者。HDR 分割为 38 Gy/4 个部分（n=321）、24 Gy/2 个部分（n=96）或 27 Gy/2 个部分（n=128）。EBRT 患者接受中位剂量为 75.6 Gy 的 1.8 Gy 分次照射[范围为 70.2-82.8 Gy]，采用三维适形或调强放疗（IMRT）。EBRT 患者通过离线自适应过程进行 3D 图像引导。
中位随访时间为 7.5 年（EBRT 为 7.4 年，HDR 为 7.9 年）。545 例患者（20.3%）接受 HDR 近距离治疗，2138 例患者（79.7%）接受 EBRT。69.1%的 EBRT 患者接受 IMRT。与 EBRT 相比，HDR 与急性≥2 级腹泻发生率降低相关（0.7% vs. 4.5%，p<0.001）、直肠疼痛/里急后重（0.6% vs. 7.9%，p<0.001）和直肠出血（0% vs. 1.6%，p=0.001）。慢性≥2 级直肠出血（1.3% vs. 8.7%，p<0.001）和放射性直肠炎（0.9% vs. 3.3%，p=0.001）的发生率也有利于 HDR 优于 EBRT。HDR 与 EBRT 相比，任何慢性直肠毒性≥2 级的发生率分别为 2.4%和 10.5%（p<0.001）。在接受 IMRT 治疗的患者中，任何严重程度≥2 级的急性和慢性胃肠道毒性发生率显著降低，但仍显著高于接受 HDR 治疗的患者。
在接受放疗的局部前列腺癌患者中，HDR 近距离治疗作为单一疗法是降低直肠毒性的有效策略。
