Xu Bichun, Zhao Xianzhi, Wei Tingting, Liang Yiyin, Zhang Weiwei, Chen Liang, Lian Zuping, Zhang Huojun
Department of Radiation Oncology, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
Department of Radiotherapy, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Immunol. 2025 Aug 13;16:1654174. doi: 10.3389/fimmu.2025.1654174. eCollection 2025.
This study aimed to compare the safety and efficacy of high-dose biologically effective dose (BED) versus standard dose regimens in stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa) using a propensity score matching (PSM) analysis.
Between June 2012 and February 2022, prostate-localized SBRT patients from two institutions were retrospectively reviewed. The high-dose group (n=12) received high-dose BED (>250Gy), and the control group (n=119) according to NCCN guidelines (35-37.5 Gy/5f, BED 198.3-225Gy). PSM was performed in a 1:4 ratio based on key clinical variables. Survival outcomes, including overall survival(OS), cancer-specific survival (CSS), biochemical progression-free survival (bPFS), local control (LC), and distant metastasis-free survival (DMFS)were analyzed using Kaplan-Meier methods with SPSS v26.
In the 7-year follow-up, the high-dose group exhibited a 66.7% OS rate vs. 83.4% in controls (p=0.402) and an 88.9% CSS rate compared to 90.5% in controls (p=0.480). The high-dose group demonstrated a 91.7% 7-year bPFS rate, while controls had a 67.4% rate (p=0.497). Higher gleason score correlated with impaired biochemical control (p=0.028), and adverse NCCN classifications indicated suboptimal control (p=0.028). The high-dose group achieved a 100% 7-year LC rate vs. 95.1% in controls (p=0.569) and a 91.7% 7-year DMFS rate compared to 81.6% in controls (p=0.918). Patients with pre-existing health conditions were less likely to develop distant metastasis (p=0.047). Most patients tolerated SBRT with minimal toxicity, and no grade 3 or higher adverse events were observed.
Escalating the biologically effective dose above standard levels did not yield a significant improvement in tumor control or survival outcomes compared to conventional SBRT dosing for localized PCa. Further prospective studies are warranted to clarify the role of dose escalation in this setting.
本研究旨在通过倾向评分匹配（PSM）分析，比较高剂量生物等效剂量（BED）与标准剂量方案在立体定向体部放射治疗（SBRT）治疗局限性前列腺癌（PCa）中的安全性和有效性。
回顾性分析2012年6月至2022年2月期间来自两家机构的前列腺局限性SBRT患者。高剂量组（n = 12）接受高剂量BED（>250Gy），对照组（n = 119）按照美国国立综合癌症网络（NCCN）指南（35 - 37.5 Gy/5次，BED 198.3 - 225Gy）治疗。根据关键临床变量以1:4的比例进行PSM。使用SPSS v26软件，采用Kaplan-Meier方法分析生存结局，包括总生存期（OS）、癌症特异性生存期（CSS）、生化无进展生存期（bPFS）、局部控制率（LC）和远处转移无进展生存期（DMFS）。
在7年随访中，高剂量组的OS率为66.7%，而对照组为83.4%（p = 0.402）；CSS率为88.9%，对照组为90.5%（p = 0.480）。高剂量组7年bPFS率为91.7%，而对照组为67.4%（p = 0.497）。较高的 Gleason评分与生化控制受损相关（p = 0.028），NCCN不良分类表明控制欠佳（p = 0.028）。高剂量组7年LC率达到100%，对照组为95.1%（p = 0.569）；7年DMFS率为91.7%，对照组为81.6%（p = 0.918）。已有健康问题的患者发生远处转移的可能性较小（p = 0.047）。大多数患者对SBRT耐受性良好，毒性极小，未观察到3级或更高等级的不良事件。
与局限性PCa的传统SBRT剂量相比，将生物等效剂量提高到标准水平以上并未在肿瘤控制或生存结局方面产生显著改善。有必要进行进一步的前瞻性研究以阐明剂量递增在此情况下的作用。
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