Musunuru Hima Bindu, Cheung Patrick, Vesprini Danny, Liu Stanley K, Chu William, Chung Hans T, Morton Gerard, Deabreu Andrea, Davidson Melanie, Ravi Ananth, Helou Joelle, Ho Ling, Zhang Liying, Loblaw Andrew
Department of Radiation Oncology, University of Pittsburg, United States.
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
Radiother Oncol. 2021 Aug;161:40-46. doi: 10.1016/j.radonc.2021.05.024. Epub 2021 Jun 3.
The ASCO/CCO guidelines recommend brachytherapy (BT) boost for eligible intermediate- (IR) or high-risk (HR) prostate cancer (PCa) patients. We present efficacy, toxicity and quality-of-life (QoL) outcomes in patients treated on a prospective protocol of MRI dose-painted high-dose-rate BT boost (HDR-BT) followed by 5-fraction pelvic radiotherapy (RT) and 6-18 months of androgen deprivation therapy (ADT).
In this phase I/II study, IR or HR PCa patients received HDR-BT 15 Gy × 1 to prostate and up to 22.5 Gy to MRI nodule, followed by 25 Gy in 5, weekly fractions to pelvis. Toxicity was assessed using CTCAEv3.0, and QoL was captured using EPIC questionnaire. Biochemical failure (BF; nadir + 2.0), and proportion of patients with PSA < 0.4 ng/ml at 4-years (4yPSARR) were evaluated. A minimally clinically important change (MCIC) was recorded if QoL score decreased >0.5 standard deviation of baseline scores.
Thirty-one patients (NCCN 3.2% favorable IR, 48.4% unfavorable IR and 48.4% HR) completed treatment with a median follow-up of 61 months. Median D90 to MR nodule was 19.0 Gy and median prostate V100% was 96.5%. The actuarial 5-year BF rate was 18.2%, and the 4yPSARR was 71%. One patient died of PCa. Acute grade 2 and 3 toxicities: GU: 50%, 7%, and GI: 3%, none, respectively. Late grade 2 and 3 toxicities were: GU: 23%, 3%, and GI: 7%, none, respectively. Proportion of patients with MCIC was 7.7% for urinary domain and 32.0% for bowel domain.
This novel treatment protocol incorporating MRI dose-painted HDR-BT boost and 5-fraction pelvic RT with ADT is well tolerated.
美国临床肿瘤学会（ASCO）/加拿大放射肿瘤学会（CCO）指南推荐对符合条件的中危（IR）或高危（HR）前列腺癌（PCa）患者进行近距离放疗（BT）强化治疗。我们报告了接受前瞻性MRI剂量勾画高剂量率BT强化治疗（HDR-BT），随后进行5次分割盆腔放疗（RT）和6 - 18个月雄激素剥夺治疗（ADT）的患者的疗效、毒性和生活质量（QoL）结果。
在这项I/II期研究中，IR或HR PCa患者接受前列腺HDR-BT 15 Gy×1次，MRI结节最高达22.5 Gy，随后盆腔每周5次分割给予25 Gy。使用CTCAEv3.0评估毒性，使用EPIC问卷收集QoL。评估生化失败（BF；最低点+2.0）以及4年时PSA<0.4 ng/ml的患者比例（4yPSARR）。如果QoL评分下降超过基线评分的0.5个标准差，则记录为最小临床重要变化（MCIC）。
31例患者（NCCN 3.2%有利的IR，48.4%不利的IR和48.4% HR）完成治疗，中位随访61个月。MRI结节的中位D90为19.0 Gy，前列腺V100%的中位值为96.5%。5年精算BF率为18.2%，4yPSARR为71%。1例患者死于PCa。急性2级和3级毒性：泌尿系统：50%，7%，胃肠道：3%，无。晚期2级和3级毒性分别为：泌尿系统：23%，3%，胃肠道：7%，无。泌尿系统MCIC患者比例为7.7%，肠道为32.0%。
这种包含MRI剂量勾画HDR-BT强化治疗、5次分割盆腔RT和ADT的新型治疗方案耐受性良好。
