超低剂量率近距离放射治疗（uLDR-BT）治疗中危高危组前列腺癌患者的回顾性分析
Ultra-low dose rate brachytherapy (uLDR-BT) in treatment of patients with unfavorable intermediate-risk group prostate cancer - retrospective analysis.
作者信息
Kluska Adam, Chyrek Artur, Burchardt Wojciech Maria, Włodarczyk Marcin, Bielęda Grzegorz, Chicheł Adam
机构信息
Brachytherapy Department, Greater Poland Cancer Centre, Poznan, Poland.
Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland.
出版信息
Rep Pract Oncol Radiother. 2024 Dec 4;29(5):600-605. doi: 10.5603/rpor.103135. eCollection 2024.
BACKGROUND
Treatment with sole ultra-low dose rate brachytherapy (uLDR-BT) for unfavorable intermediate risk factor (IUR) group prostate cancer patients is not recommended by guidelines due to the lack of strong evidence of its effectiveness. However, there were numerous patients treated with good results with this method in older trials. Purpose of this work was to retrospectively asses effectiveness of uLDR-BT in IUR group treated in our department.
MATERIALS AND METHODS
We performed retrospective analysis of 39 IUR prostate cancer patients treated in our department with uLDR-BT between 2015-2019. All Patients had confirmed prostate cancer in biopsy and had local staging assessed with digital rectal examination and either transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI) before treatment. Treatment was performed using I seeds, and the dose prescribed to the clinical target volume was 145 Gy. After treatment, all patients were followed in our outpatient ambulatory one month after the procedure and every 3-6 months later on. Toxicity was assessed using the International Prostate Symptom Score (IPSS) and Radiation Therapy Oncology Group (RTOG) scales.
RESULTS
The median follow-up was 56,3 months [interquartile range (IQR): 36.9-73.4]. The mean nadir prostate-specific antigen (PSA) was 0.20 ng/mL (range 0.001-1.7). The actuarial 5-year biochemical failure-free survival (BFFS) was 87.02%. There was no statistically significant difference in BFFS between groups with antigen deprivation therapy (ADT) and without (p = 0.439). Analysis also showed no impact on BFFS of each intermediate group risk factors: initial PSA (iPSA) (p = 0.595). Gleason (p = 0.671) and Tumor stage (p = 0.694). There were no statistically significant differences in BFFS depending on number of those factors (p = 0.330).
CONCLUSION
The uLDR-BT may be an effective option for selected IUR prostate cancer patients.
背景
由于缺乏充分的有效性证据，指南不推荐对具有不良中间风险因素（IUR）的前列腺癌患者单纯采用超低剂量率近距离放射治疗（uLDR - BT）。然而，在早期试验中有许多患者采用这种方法治疗后效果良好。本研究的目的是回顾性评估在我们科室接受治疗的IUR组患者中uLDR - BT的有效性。
材料与方法
我们对2015年至2019年间在我们科室接受uLDR - BT治疗的39例IUR前列腺癌患者进行了回顾性分析。所有患者活检确诊为前列腺癌，治疗前通过直肠指检以及经直肠超声（TRUS）或磁共振成像（MRI）进行局部分期评估。治疗采用碘籽源，临床靶体积的处方剂量为145 Gy。治疗后，所有患者在术后1个月在我们的门诊进行随访，之后每3 - 6个月随访一次。使用国际前列腺症状评分（IPSS）和放射肿瘤学组（RTOG）量表评估毒性。
结果
中位随访时间为56.3个月[四分位间距（IQR）：36.9 - 73.4]。最低前列腺特异性抗原（PSA）平均值为0.20 ng/mL（范围0.001 - 1.7）。5年精算无生化失败生存率（BFFS）为87.02%。接受雄激素剥夺治疗（ADT）组和未接受ADT组之间的BFFS无统计学显著差异（p = 0.439）。分析还表明，各中间组风险因素对BFFS无影响：初始PSA（iPSA）（p = 0.595）、 Gleason评分（p = 0.671）和肿瘤分期（p = 0.694）。根据这些因素的数量，BFFS无统计学显著差异（p = 0.330）。
结论
对于部分IUR前列腺癌患者，uLDR - BT可能是一种有效的选择。
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