倾向评分匹配分析比较了局部前列腺癌的递增剂量调强放疗与外照射放疗加高剂量率近距离放疗。
Propensity score-matched analysis comparing dose-escalated intensity-modulated radiation therapy versus external beam radiation therapy plus high-dose-rate brachytherapy for localized prostate cancer.
机构信息
Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
出版信息
Strahlenther Onkol. 2022 Aug;198(8):735-743. doi: 10.1007/s00066-022-01953-y. Epub 2022 May 12.
PURPOSE
Dose-escalated external beam radiation therapy (EBRT) and EBRT + high-dose-rate brachytherapy (HDR-BT) boost are guideline-recommended treatment options for localized prostate cancer. The purpose of this study was to compare long-term outcome and toxicity of dose-escalated EBRT versus EBRT + HDR-BT boost.
METHODS
From 2002 to 2019, 744 consecutive patients received either EBRT or EBRT + HDR-BT boost, of whom 516 patients were propensity score matched. Median follow-up was 95.3 months. Cone beam CT image-guided EBRT consisted of 33 fractions of intensity-modulated radiation therapy with simultaneous integrated boost up to 76.23 Gy (D). Combined treatment was delivered as 46 Gy (D) EBRT, followed by two fractions HDR-BT boost with 9 Gy (D). Propensity score matching was applied before analysis of the primary endpoint, estimated 10-year biochemical relapse-free survival (bRFS), and the secondary endpoints metastasis-free survival (MFS) and overall survival (OS). Prognostic parameters were analyzed by Cox proportional hazard modelling. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation used the Common Toxicity Criteria for Adverse Events (v5.0).
RESULTS
The estimated 10-year bRFS was 82.0% vs. 76.4% (p = 0.075) for EBRT alone versus combined treatment, respectively. The estimated 10-year MFS was 82.9% vs. 87.0% (p = 0.195) and the 10-year OS was 65.7% vs. 68.9% (p = 0.303), respectively. Cumulative 5‑year late GU ≥ grade 2 toxicities were seen in 23.6% vs. 19.2% (p = 0.086) and 5‑year late GI ≥ grade 2 toxicities in 11.1% vs. 5.0% of the patients (p = 0.002); cumulative 5‑year late grade 3 GU toxicity occurred in 4.2% vs. 3.6% (p = 0.401) and GI toxicity in 1.0% vs. 0.3% (p = 0.249), respectively.
CONCLUSION
Both treatment groups showed excellent long-term outcomes with low rates of severe toxicity.
目的
大剂量外照射放疗（EBRT）联合 EBRT+高剂量率近距离放疗（HDR-BT）加量是局部前列腺癌的推荐治疗选择。本研究旨在比较大剂量 EBRT 与 EBRT+HDR-BT 加量的长期疗效和毒性。
方法
2002 年至 2019 年，744 例连续患者接受 EBRT 或 EBRT+HDR-BT 加量治疗，其中 516 例患者进行了倾向评分匹配。中位随访时间为 95.3 个月。锥形束 CT 图像引导的 EBRT 包括 33 次强度调制放疗，同时进行同步整合加量至 76.23Gy（D）。联合治疗采用 46Gy（D）EBRT，随后进行两次 9Gy（D）HDR-BT 加量。在分析主要终点、估计的 10 年生化无复发生存率（bRFS）以及次要终点无转移生存率（MFS）和总生存率（OS）之前，应用了倾向评分匹配。使用癌症治疗常见毒性标准（v5.0）评估泌尿生殖系统（GU）/胃肠道（GI）毒性。
结果
单独接受 EBRT 的患者估计 10 年 bRFS 为 82.0%，而联合治疗组为 76.4%（p=0.075）。估计 10 年 MFS 分别为 82.9%和 87.0%（p=0.195），10 年 OS 分别为 65.7%和 68.9%（p=0.303）。5 年累积晚期 GU≥2 级毒性分别为 23.6%和 19.2%（p=0.086），5 年累积晚期 GI≥2 级毒性分别为 11.1%和 5.0%（p=0.002）。5 年累积晚期 GU 3 级毒性分别为 4.2%和 3.6%（p=0.401），GI 毒性分别为 1.0%和 0.3%（p=0.249）。
结论
两组治疗均显示出优异的长期疗效，且严重毒性发生率低。
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