高剂量率和低剂量率近距离放疗对前列腺癌患者接受外照射放疗后毒性、功能和癌症结局的影响：一项全国性基于人群的研究。
Impact of High-Dose-Rate and Low-Dose-Rate Brachytherapy Boost on Toxicity, Functional and Cancer Outcomes in Patients Receiving External Beam Radiation Therapy for Prostate Cancer: A National Population-Based Study.
机构信息
Department of Health Services Research and Policy, LSHTM, London, UK; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
Department of Health Services Research and Policy, LSHTM, London, UK; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
出版信息
Int J Radiat Oncol Biol Phys. 2021 Apr 1;109(5):1219-1229. doi: 10.1016/j.ijrobp.2020.11.023. Epub 2020 Dec 3.
PURPOSE
External beam radiation therapy (EBRT) with brachytherapy boost reduces cancer recurrence in patients with prostate cancer compared with EBRT monotherapy. However, randomized controlled trials or large-scale observational studies have not compared brachytherapy boost types directly.
METHODS AND MATERIALS
This observational cohort study used linked national cancer registry data, radiation therapy data, administrative hospital data, and mortality records of 54,642 patients with intermediate-risk, high-risk, and locally advanced prostate cancer in England. The records of 11,676 patients were also linked to results from a national patient survey collected at least 18 months after diagnosis. Competing risk regression analyses were used to compare gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, skeletal-related events (SRE), and prostate cancer-specific mortality (PCSM) at 5 years with adjustment for patient and tumor characteristics. Linear regression was used to compare Expanded Prostate Cancer Index Composite 26-item version domain scores (scale, 0-100, with higher scores indicating better function).
RESULTS
Five-year GI toxicity was significantly increased after low-dose-rate brachytherapy boost (LDR-BB) (32.3%) compared with high-dose-rate brachytherapy boost (HDR-BB) (16.7%) or EBRT monotherapy (18.7%). Five-year GU toxicity was significantly increased after both LDR-BB (15.8%) and HDR-BB (16.6%), compared with EBRT monotherapy (10.4%). These toxicity patterns were matched by the mean patient-reported bowel function scores (LDR-BB, 77.3; HDR-BB, 85.8; EBRT monotherapy, 84.4) and the mean patient-reported urinary obstruction/irritation function scores (LDR-BB, 72.2; HDR-BB, 78.9; EBRT monotherapy, 83.8). Five-year incidences of SREs and PCSM were significantly lower after HDR-BB (2.4% and 2.7%, respectively) compared with EBRT monotherapy (2.8% and 3.5%, respectively).
CONCLUSIONS
Compared with EBRT monotherapy, LDR-BB has worse GI and GU toxicity and HDR-BB has worse GU toxicity. HDR-BB has a lower incidence of SREs and PCSM than EBRT monotherapy.
目的
与单纯外照射放射疗法（EBRT）相比，外照射放射疗法联合近距离放射疗法（EBRT 联合近距离放射疗法）可降低前列腺癌患者的癌症复发率。然而，随机对照试验或大规模观察性研究并未直接比较近距离放射疗法的类型。
方法和材料
本观察性队列研究使用了英国 54642 例中危、高危和局部晚期前列腺癌患者的全国癌症登记处数据、放射治疗数据、行政医院数据和死亡率记录，以及至少在诊断后 18 个月进行的全国患者调查的结果对 11676 例患者的记录进行了链接。采用竞争风险回归分析，调整患者和肿瘤特征后，比较 5 年时的胃肠道（GI）毒性、泌尿生殖系统（GU）毒性、骨骼相关事件（SRE）和前列腺癌特异性死亡率（PCSM）。采用线性回归比较扩展前列腺癌指数复合 26 项版本域评分（范围，0-100，得分越高表示功能越好）。
结果
低剂量率近距离放射疗法（LDR-BB）后 5 年 GI 毒性显著增加（32.3%），而高剂量率近距离放射疗法（HDR-BB）（16.7%）或 EBRT 单药治疗（18.7%）。LDR-BB（15.8%）和 HDR-BB（16.6%）后 5 年 GU 毒性均显著增加，而 EBRT 单药治疗（10.4%）。这些毒性模式与患者报告的平均肠道功能评分（LDR-BB，77.3；HDR-BB，85.8；EBRT 单药治疗，84.4）和患者报告的平均尿梗阻/刺激功能评分（LDR-BB，72.2；HDR-BB，78.9；EBRT 单药治疗，83.8）相匹配。HDR-BB 后 5 年 SRE 和 PCSM 的发生率明显低于 EBRT 单药治疗（分别为 2.4%和 2.7%）。
结论
与 EBRT 单药治疗相比，LDR-BB 的 GI 和 GU 毒性更差，HDR-BB 的 GU 毒性更差。HDR-BB 的 SRE 和 PCSM 发生率低于 EBRT 单药治疗。
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