Patel Sagar A, Kollmeier Marisa, Crook Juanita, Krauss Daniel, Morton Gerard, Chang Albert J, Helou Joelle, Hsu I-Chow, Menard Cynthia, Patel Shyamal, Robin Tyler, Rossi Peter J, Zelefsky Michael J, Kamrava Mitchell R
Department of Radiation Oncology & Urology, Emory University, Atlanta, GA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
Brachytherapy. 2025 Sep-Oct;24(5):644-662. doi: 10.1016/j.brachy.2025.06.005. Epub 2025 Jul 23.
This guideline presents evidence-based consensus recommendations for high-dose-rate (HDR) brachytherapy boost in combination with external beam radiotherapy (EBRT) for the primary treatment of localized prostate cancer.
The American Brachytherapy Society convened a task force for addressing key questions concerning prostate HDR brachytherapy boost with EBRT for the primary treatment of localized prostate cancer. A comprehensive literature search was conducted to identify prospective and large retrospective studies involving HDR brachytherapy combined with EBRT. Outcomes of interest included biochemical and/or disease control, toxicity, patient-reported quality of life, and the role of androgen deprivation therapy.
HDR brachytherapy using Ir-192 in combination with EBRT is an appropriate treatment option for men with intermediate- and high-risk prostate cancer. CT, ultrasound, and/or MRI are imaging platforms that may be utilized for treatment planning and delivery. A single implant/fraction of 15 Gy or 2 implants/fractions of 9.5-11 Gy each are acceptable regimens in combination with EBRT at a dose equivalent of 45-50.4 Gy in 1.8-2.0 Gy fractions. The addition of HDR brachytherapy is expected to improve biochemical control compared with dose escalated EBRT alone. HDR brachytherapy boost is expected to achieve similar biochemical control outcomes as a low dose rate (LDR) brachytherapy boost. Androgen deprivation therapy is recommended for men with unfavorable intermediate and high-risk disease, with varying duration dependent on cancer risk. Use of an HDR brachytherapy technique, as opposed to LDR permanent seeds, has been shown to have less acute genitourinary (GU) and gastrointestinal (GI) toxicity following treatment.
For men with intermediate- and high-risk prostate cancer, HDR brachytherapy boost is a safe and effective technique for dose-escalation that can achieve superior biochemical control compared with EBRT alone, possibly with an improved GU and GI side effect profile compared with an LDR brachytherapy technique.
本指南针对高剂量率（HDR）近距离放射治疗联合外照射放疗（EBRT）用于局限性前列腺癌的初始治疗提出基于证据的共识性建议。
美国近距离放射治疗协会召集了一个特别工作组，以解决有关前列腺癌HDR近距离放射治疗联合EBRT用于局限性前列腺癌初始治疗的关键问题。进行了全面的文献检索，以确定涉及HDR近距离放射治疗联合EBRT的前瞻性和大型回顾性研究。感兴趣的结果包括生化和/或疾病控制、毒性、患者报告的生活质量以及雄激素剥夺治疗的作用。
使用铱-192的HDR近距离放射治疗联合EBRT是中高危前列腺癌男性的一种合适治疗选择。CT、超声和/或MRI是可用于治疗计划和实施的成像平台。单次植入/分次给予15 Gy或两次植入/每次分次给予9.5 - 11 Gy是可接受的方案，联合EBRT时剂量等效于45 - 50.4 Gy，分1.8 - 2.0 Gy分次给予。与单纯剂量递增的EBRT相比，添加HDR近距离放射治疗有望改善生化控制。HDR近距离放射治疗增敏预期可实现与低剂量率（LDR）近距离放射治疗增敏相似的生化控制结果。对于具有不良中高危疾病的男性，建议进行雄激素剥夺治疗，持续时间因癌症风险而异。与LDR永久种子相比，使用HDR近距离放射治疗技术已显示在治疗后具有较低的急性泌尿生殖系统（GU）和胃肠道（GI）毒性。
对于中高危前列腺癌男性，HDR近距离放射治疗增敏是一种安全有效的剂量递增技术，与单独的EBRT相比可实现更好的生化控制，与LDR近距离放射治疗技术相比可能具有改善的GU和GI副作用情况。
