Yamazaki Hideya, Suzuki Gen, Masui Koji, Aibe Norihiro, Shimizu Daisuke, Kimoto Takuya, Yamada Kei, Okihara Koji, Ueda Takashi, Narukawa Tsukasa, Shiraishi Takumi, Fujihara Atsuko, Yoshida Ken, Nakamura Satoaki, Kato Takashi, Hashimoto Yasutoshi, Okabe Haruumi
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 Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Cancers (Basel). 2022 Jun 16;14(12):2976. doi: 10.3390/cancers14122976.
This study examined the role of brachytherapy boost (BT-boost) and external beam radiotherapy (EBRT) in intermediate- to high-risk prostate cancer, especially in patients with very high-risk factors (VHR: T3b-4 or Gleason score 9-10) as patients with double very high-risk factors (VHR-2: T3b-4 and Gleason score 9-10) previously showed worst prognosis in localized prostate cancer. We retrospectively reviewed multi-institutional data of 1961 patients that were administered radiotherapy (1091 BT-boost and 872 EBRT: 593 conventional-dose RT (Conv RT: equivalent to doses of 2 Gy per fraction = EQD2 ≤ 72 Gy) and 216 dose-escalating RT (DeRT = EQD2 ≥ 74 Gy). We found that BT-boost improved PSA control and provided an equivalent overall survival rate in the intermediate- and high-risk groups, except for patients within the VHR factor group. In the VHR-1 group (single VHR), BT-boost showed a superior biochemical control rate to the Conv RT group but not to the DeRT group. In the VHR-2 group, BT-boost did not improve outcomes of either Conv RT or DeRT groups. In conclusion, BT-boost showed no benefit to modern DeRT in the patients with VHR; therefore, they are not good candidates for BT-boost to improve outcome and may be amenable to clinical trials using multimodal intensified systemic treatments.
本研究探讨了近距离放疗增敏（BT增敏）和外照射放疗（EBRT）在中高危前列腺癌中的作用，尤其是在具有极高危因素（VHR：T3b - 4或 Gleason评分9 - 10）的患者中，因为先前显示具有双重极高危因素（VHR - 2：T3b - 4且Gleason评分9 - 10）的局限性前列腺癌患者预后最差。我们回顾性分析了1961例接受放疗患者的多机构数据（1091例BT增敏和872例EBRT：593例常规剂量放疗（Conv RT：相当于每次分割剂量2 Gy = EQD2≤72 Gy）和216例剂量递增放疗（DeRT = EQD2≥74 Gy））。我们发现，除VHR因素组患者外，BT增敏改善了中高危组患者的PSA控制情况并提供了相当的总生存率。在VHR - 1组（单一VHR）中，BT增敏显示出比Conv RT组更好的生化控制率，但不比DeRT组好。在VHR - 2组中，BT增敏并未改善Conv RT组或DeRT组的治疗效果。总之，BT增敏对VHR患者的现代DeRT无益处；因此，他们不是BT增敏改善预后的合适人选，可能适合采用多模式强化全身治疗的临床试验。
