Willen Benjamin D, Salari Kamran, Zureick Andrew H, Lang Doyle, Ye Hong, Marvin Kimberly, Nandalur Sirisha R, Krauss Daniel J
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI.
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI.
Brachytherapy. 2023 Sep-Oct;22(5):571-579. doi: 10.1016/j.brachy.2023.05.002. Epub 2023 Jun 14.
High-dose-rate brachytherapy as monotherapy (HDR-M), or as a boost combined with external beam radiotherapy (HDR-B), are both suitable treatments for intermediate-risk prostate cancer. However, data directly comparing these two approaches for men with unfavorable intermediate-risk (UIR) patients are lacking.
Patients with NCCN-defined UIR prostate cancer treated from 1997 to 2020 were identified in a prospectively maintained, single institution database. HDR-M and HDR-B patients were matched using three factors: age ±3 years; Gleason score (major and minor); and clinical T stage. Biochemical failure was defined as PSA nadir (nPSA) + 2. Available acute and chronic toxicities are additionally reported.
A total of 247 patients were identified (170 receiving HDR-B, 77 receiving HDR-M), ultimately yielding 70 matched pairs (140 patients) for inclusion. The median followup time was 5.2 years for HDR-M compared with 9.3 years for HDR-B (p < 0.001). The two cohorts had similar calculated prostate EQD2 (HDR-B 118 Gy vs. HDR-M 115 Gy, p = 0.977). No significant differences in OS, CSS, DM, LRR, or FFBF were identified. HDR-B had an increased rate of any acute grade 2+ gastrointestinal toxicity and worse acute dysuria and diarrhea. Chronic gastrointestinal and genitourinary toxicity was similar.
These data suggest that HDR brachytherapy as monotherapy is an effective treatment option for selected patients with unfavorable intermediate-risk prostate cancer and provides a more favorable gastrointestinal toxicity profile than HDR-B. Prospective trials should be conducted to refine the selection process for this heterogeneous cohort of patients.
高剂量率近距离放射治疗作为单一疗法（HDR-M），或作为外照射放疗联合的增敏治疗（HDR-B），都是中危前列腺癌的合适治疗方法。然而，缺乏直接比较这两种方法对预后不良的中危（UIR）患者疗效的数据。
在一个前瞻性维护的单机构数据库中，识别出1997年至2020年接受美国国立综合癌症网络（NCCN）定义的UIR前列腺癌治疗的患者。使用三个因素对HDR-M和HDR-B患者进行匹配：年龄±3岁； Gleason评分（主要和次要）；以及临床T分期。生化失败定义为前列腺特异抗原最低点（nPSA）+2。另外报告了可用的急性和慢性毒性。
共识别出247例患者（170例接受HDR-B，77例接受HDR-M），最终产生70对匹配对（140例患者）纳入研究。HDR-M的中位随访时间为5.2年，而HDR-B为9.3年（p<0.001）。两个队列计算出的前列腺等效剂量2（EQD2）相似（HDR-B为118 Gy，HDR-M为115 Gy，p = 0.977）。在总生存期（OS）、无病生存期（CSS）、远处转移（DM）、局部区域复发（LRR）或无远处转移的无生化失败生存期（FFBF）方面未发现显著差异。HDR-B的任何2级及以上急性胃肠道毒性发生率增加，急性排尿困难和腹泻更严重。慢性胃肠道和泌尿生殖系统毒性相似。
这些数据表明，高剂量率近距离放射治疗作为单一疗法是选定的预后不良的中危前列腺癌患者的有效治疗选择，并且比HDR-B具有更有利的胃肠道毒性特征。应进行前瞻性试验以完善针对这一异质性患者群体的选择过程。
