立体定向体部放射治疗和高剂量率近距离放疗联合调强放疗治疗局限性前列腺癌：单机构倾向评分匹配分析。
Stereotactic Body Radiation Therapy and High-Dose-Rate Brachytherapy Boost in Combination With Intensity Modulated Radiation Therapy for Localized Prostate Cancer: A Single-Institution Propensity Score Matched Analysis.
机构信息
Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, California; Division of Biostatistics, University of California San Francisco, San Francisco, California.
出版信息
Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):429-437. doi: 10.1016/j.ijrobp.2020.12.034. Epub 2020 Dec 30.
PURPOSE
To perform a propensity-score matched analysis comparing stereotactic body radiation therapy (SBRT) boost and high-dose-rate (HDR) boost for localized prostate cancer.
METHODS AND MATERIALS
A single-institution retrospective chart review was conducted of men treated with pelvic external beam radiation therapy (EBRT) and SBRT boost (21 Gy and 19 Gy in 2 fractions) to the prostate for prostate cancer. A cohort treated at the same institution with HDR brachytherapy boost (19 Gy in 2 fractions) was compared. Propensity-score (PS) matching and multivariable Cox regression were used for analysis. Outcomes were biochemical recurrence freedom (BCRF) and metastasis freedom (MF).
RESULTS
One hundred thirty-one men were treated with SBRT boost and 101 with HDR boost with median follow-up of 73.4 and 186.0 months, respectively. In addition, 68.8% of men had high-risk and 26.0% had unfavorable-intermediate disease, and 94.3% received androgen deprivation therapy. Five- and 10-year unadjusted BCRF was 88.8% and 85.3% for SBRT and 91.8% and 74.6% for HDR boost (log-rank P = .3), and 5- and 10-year unadjusted MF was 91.7% and 84.3% for SBRT and 95.8% and 82.0% for HDR (log-rank P = .8). After adjusting for covariates, there was no statistically significant difference in BCRF (hazard ratio [HR] 0.81; 95% confidence interval [CI], 0.37-1.79; P = .6) or MF (HR 1.07; 95% CI, 0.44-2.57; P = .9) between SBRT and HDR boost. Similarly, after PS matching, there was no statistically significant difference between SBRT and HDR (BCRF: HR 0.66, 0.27-1.62, P = .4; MF: HR 0.84, 0.31-2.26, P = .7). Grade 3+ genitourinary and gastrointestinal toxicity in the SBRT cohort were 4.6% and 1.5%, and 3.0% and 0.0% in the HDR cohorts (P = .4, Fisher exact test).
CONCLUSIONS
SBRT boost plus pelvic EBRT for prostate cancer resulted in similar BCRF and MF to HDR boost in this single institution, PS matched retrospective analysis. Toxicity was modest. Prospective evaluation of SBRT boost for the treatment of unfavorable-intermediate and high-risk prostate cancer is warranted.
目的
通过倾向评分匹配分析比较局部前列腺癌的立体定向体部放射治疗（SBRT）加量与高剂量率（HDR）加量。
方法和材料
对在同一机构接受盆腔外照射放疗（EBRT）和 SBRT 加量（前列腺 21 Gy 和 19 Gy 分 2 次）治疗前列腺癌的患者进行了单中心回顾性图表审查。与接受 HDR 近距离治疗加量（前列腺 19 Gy 分 2 次）的队列进行了比较。采用倾向评分（PS）匹配和多变量 Cox 回归进行分析。结果是生化无复发生存（BCRF）和转移无复发生存（MF）。
结果
131 名患者接受 SBRT 加量治疗，101 名患者接受 HDR 加量治疗，中位随访时间分别为 73.4 和 186.0 个月。此外，68.8%的患者患有高危疾病，26.0%的患者患有不利的中危疾病，94.3%的患者接受了雄激素剥夺治疗。未调整的 5 年和 10 年 BCRF 分别为 SBRT 组的 88.8%和 85.3%，HDR 组的 91.8%和 74.6%（对数秩 P =.3），未调整的 5 年和 10 年 MF 分别为 SBRT 组的 91.7%和 84.3%，HDR 组的 95.8%和 82.0%（对数秩 P =.8）。调整协变量后，SBRT 和 HDR 之间的 BCRF（风险比 [HR] 0.81；95%置信区间 [CI]，0.37-1.79；P =.6）或 MF（HR 1.07；95% CI，0.44-2.57；P =.9）无统计学显著差异。同样，在 PS 匹配后，SBRT 和 HDR 之间也无统计学显著差异（BCRF：HR 0.66，0.27-1.62，P =.4；MF：HR 0.84，0.31-2.26，P =.7）。SBRT 组的 3+级泌尿生殖和胃肠道毒性分别为 4.6%和 1.5%，HDR 组分别为 3.0%和 0.0%（P =.4，Fisher 确切检验）。
结论
在这项单中心、PS 匹配的回顾性分析中，SBRT 加量联合盆腔 EBRT 治疗前列腺癌，与 HDR 加量相比，BCRF 和 MF 相似。毒性较小。需要前瞻性评估 SBRT 加量治疗不利中危和高危前列腺癌。
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