Patel Mira, Turchan William Tyler, Morris Christopher G, Augustine Dana, Wu Tianming, Oto Aytek, Zagaja Gregory P, Liauw Stanley L
Department of Radiation Oncology, University of Chicago Medicine, Chicago, IL 60637, USA.
Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA.
Cancers (Basel). 2023 Feb 20;15(4):1336. doi: 10.3390/cancers15041336.
We examined a prospective consecutive cohort of low dose rate (LDR) brachytherapy for prostate cancer to evaluate the efficacy of monotherapy for unfavorable-intermediate risk (UIR) disease, and explore factors associated with toxicity and quality of life (QOL).
149 men with prostate cancer, including 114 staged with MRI, received Iodine-125 brachytherapy alone (144-145 Gy) or following external beam radiation therapy (110 Gy; EBRT). Patient-reported QOL was assessed by the Expanded Prostate Index Composite (EPIC) survey, and genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively recorded (CTC v4.0). Global QOL scores were assessed for decline greater than the minimum clinically important difference (MCID). Univariate analysis (UVA) was performed, with 30-day post-implant dosimetry covariates stratified into quartiles. Median follow-up was 63 mo.
Men with NCCN low ( = 42) or favorable-intermediate risk ( = 37) disease were treated with brachytherapy alone, while most with high-risk disease had combined EBRT ( = 17 of 18). Men with UIR disease ( = 52) were selected for monotherapy ( = 42) based on clinical factors and MRI findings. Freedom from biochemical failure-7 yr was 98%. Of 37 men with MRI treated with monotherapy for UIR disease, all 36 men without extraprostatic extension were controlled. Late Grade 2+/3+ toxicity occurred in 55/3% for GU and 8/2% for GI, respectively. Fifty men were sexually active at baseline and had 2 yr sexual data; 37 (74%) remained active at 2 yr. Global scores for urinary incontinence (UC), urinary irritation/obstruction (UIO), bowel function, and sexual function (SF) showed decreases greater than the MCID ( < 0.05) in UC at 2 mo, UIO at 2 and 6 mo, and SF at 2-24 mo, and >5 yr. Analysis did not reveal any significant associations with any examined rectal or urethral dosimetry for late toxicity or QOL.
Disease outcomes and patient-reported QOL support LDR brachytherapy, including monotherapy for UIR disease.
我们对一组接受低剂量率（LDR）近距离放射治疗的前列腺癌患者进行了前瞻性连续队列研究，以评估单纯治疗对不良-中度风险（UIR）疾病的疗效，并探索与毒性和生活质量（QOL）相关的因素。
149例前列腺癌患者，其中114例进行了MRI分期，单独接受碘-125近距离放射治疗（144 - 145 Gy）或在体外放射治疗（110 Gy；EBRT）后接受该治疗。通过扩展前列腺指数综合（EPIC）调查评估患者报告的生活质量，并前瞻性记录泌尿生殖系统（GU）和胃肠道（GI）毒性（CTC v4.0）。评估总体生活质量评分下降是否大于最小临床重要差异（MCID）。进行单因素分析（UVA），将植入后30天的剂量学协变量分层为四分位数。中位随访时间为63个月。
美国国立综合癌症网络（NCCN）低风险（n = 42）或有利-中度风险（n = 37）疾病的男性仅接受近距离放射治疗，而大多数高风险疾病患者接受了联合EBRT（18例中的17例）。根据临床因素和MRI结果，选择UIR疾病患者（n = 52）进行单纯治疗（n = 42）。7年无生化失败生存率为98%。在37例接受UIR疾病单纯治疗的MRI检查患者中，所有36例无前列腺外侵犯的患者病情得到控制。晚期2级以上/3级以上毒性在GU和GI中的发生率分别为55/3%和8/2%。50名男性在基线时具有性功能，并拥有2年的性数据；37名（74%）在2年时仍有性功能。尿失禁（UC）、尿路刺激/梗阻（UIO）、肠道功能和性功能（SF）的总体评分在2个月时的UC、2和6个月时的UIO以及2 - 24个月和5年以上时的SF中显示下降大于MCID（P < 0.05）。分析未发现任何与晚期毒性或生活质量相关的直肠或尿道剂量学有显著关联。
疾病结局和患者报告的生活质量支持LDR近距离放射治疗，包括对UIR疾病的单纯治疗。
