临床局限性T3b或T4极高危前列腺癌的放射治疗——使用高剂量率近距离放疗增敏或高剂量调强放疗进行剂量递增的作用

Radiotherapy for Clinically Localized T3b or T4 Very-High-Risk Prostate Cancer-Role of Dose Escalation Using High-Dose-Rate Brachytherapy Boost or High Dose Intensity Modulated Radiotherapy.

作者信息

Yamazaki Hideya, Suzuki Gen, Masui Koji, Aibe Norihiro, Shimizu Daisuke, Kimoto Takuya, Yoshida Ken, Nakamura Satoaki, Okabe Haruumi

机构信息

Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

Department of Radiology, Kansai Medical University, Hirakata 573-1010, Japan.

出版信息

Cancers (Basel). 2021 Apr 13;13(8):1856. doi: 10.3390/cancers13081856.

To examine the efficacy of dose escalating radiotherapy into patients with cT3b or T4 localized prostate cancer, we compared Group A (86 conventional dose external beam radiotherapy: EBRT group, treated with 70-72 Gy) and group B (39 high dose EBRT group (HDEBRT group, 74-80 Gy) and 124 high-dose-rate brachytherapy (HDR) + EBRT (HDR boost)) using multi-institutional retrospective data. The actuarial 5-year biochemical disease-free survival (bDFS) rate, prostate cancer specific survival rate (PSS), and overall survival rate (OS) were 75.8%, 96.8%, and 93.5%. Group B showed superior 5-year bDFS rate (81.2%) as compared to the group A (66.5%) ( < 0.0001) with a hazard ratio of 0.397. Equivocal 5-year PSS (98.3% and 94.8% in group B and group A) and OS (both 93.7%) were found between those groups. Accumulated late grade ≥ 2 toxicities in gastrointestinal and genitourinary tracts were similar among those three groups. Therefore, both HDEBRT and HDR boost could be good options for improving the bDFS rate in cT3-T4 localized prostate cancer without affecting PSS and OS.

为了研究剂量递增放疗对cT3b或T4期局限性前列腺癌患者的疗效，我们使用多机构回顾性数据比较了A组（86例接受常规剂量外照射放疗：EBRT组，剂量为70 - 72 Gy）和B组（39例接受高剂量EBRT组（HDEBRT组，剂量为74 - 80 Gy）以及124例接受高剂量率近距离放疗（HDR）+ EBRT（HDR推量））。精算5年无生化疾病生存率（bDFS）、前列腺癌特异性生存率（PSS）和总生存率（OS）分别为75.8%、96.8%和93.5%。与A组（66.5%）相比，B组的5年bDFS率更高（81.2%）（<0.0001），风险比为0.397。两组之间的5年PSS（B组和A组分别为98.3%和94.8%）和OS（均为93.7%）相近。三组胃肠道和泌尿生殖道累积的≥2级晚期毒性反应相似。因此，HDEBRT和HDR推量都是提高cT3 - T4期局限性前列腺癌bDFS率且不影响PSS和OS的良好选择。