Poder Joel, Hoskin Peter, Reynolds Hayley, Him Chan Tsz, Haworth Annette
St George Hospital Cancer Care Centre, Kogarah, NSW, Australia.
Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
Phys Imaging Radiat Oncol. 2024 Sep 16;32:100645. doi: 10.1016/j.phro.2024.100645. eCollection 2024 Oct.
Focal boost to intra-prostatic lesions (IPLs) in radiotherapy could enhance treatment efficacy. Brachytherapy (BT), delivering highly conformal dose with sharp dose gradients emerges as a potentially optimal approach for precise dose escalation to IPLs. This study aims to consolidate clinical and planning studies that implemented whole gland prostate BT and focal dose escalation to IPLs, with the view to synthesize evidence on the strategy's effectiveness and variability. In this review, we identified nine clinical studies and ten planning/simulation studies focusing on whole gland prostate BT with IPL dose escalation. From the clinical studies, the use of whole gland prostate BT with focal dose escalation in combination with external beam radiotherapy (EBRT) appears to be a safe and effective 21 form of treatment for men with T1b - T2c prostate cancer with average five-year biochemical failure22 free survival (BFFS) of 94 % (range 81.1 %-100 %) and minimal grade three toxicities reported. Both clinical and planning studies exemplified the high level of focal dose escalation achievable using BT with a mean IPL D90 % of 132 % and 146 %, respectively (expressed as a % of the whole gland prescription dose). There was considerable variation in the reporting of clinical and technical data in the identified studies. To facilitate a more widespread and uniform adoption of the technique, recommendations on essential and desirable items to be included in future studies incorporating whole gland prostate BT with focal boost to IPLs are provided.
放疗中对前列腺内病变（IPLs）进行局部剂量增强可提高治疗效果。近距离放射治疗（BT）能够提供高度适形的剂量且剂量梯度锐利，成为对IPLs进行精确剂量递增的潜在最佳方法。本研究旨在整合实施全腺前列腺BT及对IPLs进行局部剂量递增的临床和计划研究，以期综合该策略有效性和变异性方面的证据。在本综述中，我们确定了9项临床研究和10项计划/模拟研究，这些研究聚焦于全腺前列腺BT及IPL剂量递增。从临床研究来看，对于T1b - T2c期前列腺癌男性患者，全腺前列腺BT联合局部剂量递增并结合外照射放疗（EBRT）似乎是一种安全有效的治疗方式，平均五年无生化失败生存率（BFFS）为94%（范围81.1% - 100%），且报告的3级毒性极小。临床和计划研究均表明，使用BT可实现高水平的局部剂量递增，IPL的平均D90%分别为132%和146%（以全腺处方剂量的百分比表示）。在所确定的研究中，临床和技术数据的报告存在相当大的差异。为促进该技术更广泛和统一的应用，提供了关于未来纳入全腺前列腺BT及对IPLs进行局部剂量增强研究中应包含的基本和理想项目的建议。
