中高危前列腺癌患者接受低剂量率与高剂量率近距离放疗联合外照射后患者报告结局。
Patient-reported outcomes after Low-dose-rate versus High-dose-rate brachytherapy boost in combination with external beam radiation for intermediate and high risk prostate cancer.
机构信息
Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA.
Department of Biostatistics and Bioinformatics, Emory University, Atlanta GA.
出版信息
Brachytherapy. 2021 Nov-Dec;20(6):1130-1138. doi: 10.1016/j.brachy.2021.07.005. Epub 2021 Aug 18.
PURPOSE
Addition of a brachytherapy boost to external beam radiation therapy (EBRT) reduces prostate cancer (PCa) recurrence at the expense of genitourinary (GU) toxicity. Whether brachytherapy boost technique, specifically low-dose-rate (LDR-BT) versus high-dose-rate (HDR-BT), impacts treatment-related toxicity is unclear.
METHODS
Between 2012-2018, 106 men with intermediate/high risk PCa underwent EBRT (37.5-45 Gy in 1.8-2.5 Gy/fraction) plus brachytherapy boost, either with LDR-BT (110 Gy I-125 or 100 Gy Pd-103; n = 51) or HDR-BT (15 Gy x1 Ir-192; n = 55). Patient-reported outcomes (PRO) were assessed by International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC-CP) surveys at 3-6-month intervals for up to three years following treatment, with higher scores indicating more severe toxicity. Provider-reported GU and gastrointestinal (GI) toxicity was graded per CTCAE v5.0 at each follow-up. Linear mixed models comparing PROs between LDR-BT versus HDR-BT were fitted. Stepwise multivariable analysis (MVA) was performed to account for age, gland size, androgen deprivation therapy use, and alpha-blocker medication use. Incidence rates of grade 2+ GU/GI toxicity was compared using Fisher's exact test.
RESULTS
Use of LDR-BT was associated with greater change in IPSS (p=0.003) and EPIC-CP urinary irritative score (p = 0.002) compared with HDR-BT, but effect size diminished over time (LDR-BT versus HDR-BT: baseline to 6-/24-month mean IPSS change, +6.4/+1.4 versus +2.7/-3.0, respectively; mean EPIC-CP irritative/obstructive change, +2.5/+0.1 versus +0.9/+0.1, respectively). Results remained significant on MVA. Post-treatment grade 2+ GU toxicity was significantly higher in the LDR-BT group (67.5% versus 42.9% for LDR-BT and HDR-BT, respectively; p <0.001). There were no differences between groups in incontinence, bowel function, and erectile function, or grade 2+ GI toxicity.
CONCLUSION
Compared with LDR-BT, HDR-BT was associated with lower acute patient- and provider-reported GU toxicity.
目的
在外部束放射治疗（EBRT）中增加近距离放射治疗（BT）会降低前列腺癌（PCa）的复发率，但会增加泌尿生殖系统（GU）毒性。BT 增强技术，特别是低剂量率（LDR-BT）与高剂量率（HDR-BT），是否会影响治疗相关毒性尚不清楚。
方法
2012 年至 2018 年，106 名患有中/高危 PCa 的男性接受了 EBRT（37.5-45 Gy，1.8-2.5 Gy/分数）加 BT 增强，分别采用 LDR-BT（110 Gy I-125 或 100 Gy Pd-103；n=51）或 HDR-BT（15 Gy x1 Ir-192；n=55）。通过国际前列腺症状评分（IPSS）和前列腺癌指数综合量表（EPIC-CP）调查，在治疗后 3-6 个月的时间内，以 3-6 个月的间隔评估患者报告的结果（PRO），得分越高表示毒性越严重。按照 CTCAE v5.0 在每次随访时对 GU 和胃肠道（GI）毒性进行分级。使用线性混合模型比较 LDR-BT 与 HDR-BT 之间的 PRO。采用逐步多变量分析（MVA）来考虑年龄、腺体大小、雄激素剥夺治疗的使用以及 α 阻滞剂的使用。使用 Fisher 精确检验比较 2+GU/GI 毒性的发生率。
结果
与 HDR-BT 相比，LDR-BT 与 IPSS（p=0.003）和 EPIC-CP 尿激惹评分（p=0.002）的变化更大，但随着时间的推移，影响会减小（LDR-BT 与 HDR-BT：从基线到 6/24 个月的平均 IPSS 变化，分别为+6.4/+1.4 与+2.7/-3.0；平均 EPIC-CP 刺激/梗阻变化，分别为+2.5/+0.1 与+0.9/+0.1）。在 MVA 中结果仍然显著。LDR-BT 组治疗后 2+GU 毒性明显更高（LDR-BT 和 HDR-BT 组分别为 67.5%和 42.9%；p<0.001）。两组之间在尿失禁、肠道功能和勃起功能或 2+GI 毒性方面无差异。
结论
与 LDR-BT 相比，HDR-BT 与较低的急性患者和提供者报告的 GU 毒性相关。
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