接受或未接受近距离放疗增敏的外照射放疗后中高危前列腺癌的生化控制情况。
Biochemical control in intermediate- and high-risk prostate cancer after EBRT with and without brachytherapy boost.
作者信息
Moll Matthias, Magrowski Łukasz, Mittlböck Martina, Heinzl Harald, Kirisits Christian, Ciepał Jakub, Masri Oliwia, Heilemann Gerd, Stando Rafał, Krzysztofiak Tomasz, Depowska Gabriela, d'Amico Andrea, Techmański Tomasz, Kozub Anna, Majewski Wojciech, Suwiński Rafał, Wojcieszek Piotr, Sadowski Jacek, Widder Joachim, Goldner Gregor, Miszczyk Marcin
机构信息
Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
出版信息
Strahlenther Onkol. 2025 Jan;201(1):11-19. doi: 10.1007/s00066-024-02245-3. Epub 2024 Jun 3.
PURPOSE
External beam radiotherapy (EBRT) with or without brachytherapy boost (BTB) has not been compared in prospective studies using guideline-recommended radiation dose and recommended androgen-deprivation therapy (ADT). In this multicenter retrospective analysis, we compared modern-day EBRT with BTB in terms of biochemical control (BC) for intermediate-risk (IR) and high-risk (HR) prostate cancer.
METHODS
Patients were treated for primary IR or HR prostate cancer during 1999-2019 at three high-volume centers. Inclusion criteria were prescribed ≥ 76 Gy EQD2 (α/β = 1.5 Gy) for IR and ≥ 78 Gy EQD2 (α/β = 1.5 Gy) for HR as EBRT alone or with BTB. All HR patients received ADT and pelvic irradiation, which were optional in IR cases. BC between therapies was compared in survival analyses.
RESULTS
Of 2769 initial patients, 1176 met inclusion criteria: 468 HR (260 EBRT, 208 BTB) and 708 IR (539 EBRT, 169 BTB). Median follow-up was 49 and 51 months for HR and IR, respectively. BTB patients with ≥ 113 Gy EQD experienced a stable, good BC outcome compared with BTB at lower doses. Patients treated with ≥ 113 Gy EQD also experienced significantly improved BC compared with EBRT (10-year BC failure rates after ≥ 113 Gy BTB and EBRT: respectively 20.4 and 41.8% for HR and 7.5 and 20.8% for IR).
CONCLUSIONS
In patients with IR and HR prostate cancer, BTB with ≥ 113 Gy EQD offered a BC advantage compared with dose-escalated EBRT and lower BTB doses.
目的
在使用指南推荐的放射剂量和推荐的雄激素剥夺疗法（ADT）的前瞻性研究中，尚未对单纯外照射放疗（EBRT）与加或不加近距离放疗强化（BTB）进行比较。在这项多中心回顾性分析中，我们比较了现代EBRT联合BTB与单纯EBRT在中危（IR）和高危（HR）前列腺癌生化控制（BC）方面的情况。
方法
1999年至2019年期间，在三个大型中心对原发性IR或HR前列腺癌患者进行治疗。纳入标准为单独进行EBRT或联合BTB时，IR患者规定的等效剂量（EQD2，α/β = 1.5 Gy）≥76 Gy，HR患者规定的EQD2（α/β = 1.5 Gy）≥78 Gy。所有HR患者均接受ADT和盆腔照射，IR患者可选择接受。在生存分析中比较不同治疗方法之间的BC情况。
结果
在2769例初始患者中，1176例符合纳入标准：468例HR患者（260例接受EBRT，208例接受BTB）和708例IR患者（539例接受EBRT，169例接受BTB）。HR和IR患者的中位随访时间分别为49个月和51个月。与较低剂量的BTB相比，接受≥113 Gy EQD的BTB患者生化控制结果稳定且良好。与EBRT相比，接受≥113 Gy EQD治疗的患者生化控制也有显著改善（≥113 Gy BTB和EBRT后10年生化控制失败率：HR患者分别为20.4%和41.8%，IR患者分别为7.5%和20.8%）。
结论
在IR和HR前列腺癌患者中，与剂量递增的EBRT和较低剂量的BTB相比，EQD≥113 Gy的BTB在生化控制方面具有优势。
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