Direct 2-Arm Comparison Shows Benefit of High-Dose-Rate Brachytherapy Boost vs External Beam Radiation Therapy Alone for Prostate Cancer
Direct 2-Arm Comparison Shows Benefit of High-Dose-Rate Brachytherapy Boost vs External Beam Radiation Therapy Alone for Prostate Cancer
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DOI：
10.1016/j.ijrobp.2012.07.006
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发表时间：
2013-03-01
影响因子：
7
通讯作者：
Williams, Scott
中科院分区：
文献类型：
--
作者：
Khor, Richard;Duchesne, Gillian;Williams, Scott
目的：评估中高风险前列腺癌患者接受单一方案外束放射治疗（EBRT）和高剂量率近距离放射治疗（HDRB）增强或单独EBRT治疗的结果。方法和材料：从2001年到2006年，344例患者接受EBRT + HDRB增强治疗中高危前列腺癌。EBRT的处方剂量为46 Gy，分23次，HDR增加19.5 Gy，分3次。使用配对分析，将该队列与同时接受EBRT治疗的队列进行比较，该队列在37个分数中接受74 Gy的EBRT治疗。采用三维共形EBRT。使用倾向评分匹配技术进行匹配。高危患者占匹配队列的41%。分析5年临床及生化结果。结果：未匹配治疗队列之间预后指标的初始显著差异在匹配后可以忽略不计，共提供688例患者。中位生化随访为60.5个月。HDRB组和EBRT组的5年无生化失败率分别为79.8%（95%可信区间[CI]， 74.3%-85.0%）和70.9% (95% CI, 65.4%-76.0%)，风险比为0.59 （95% CI, 0.43-0.81， P= 0.0011）。相互作用分析显示，当实施计划中的雄激素剥夺治疗时，HDR的疗效没有改变（P= 0.95），但与EBRT相比，在高危病例中，HDR的疗效有明显下降的趋势（P= 0.06）。EBRT组和HDRB组3级尿道狭窄发生率分别为0.3% （95% CI, 0% ~ 0.9%）和11.8% （95% CI, 8.1% ~ 16.5%）
Purpose: To evaluate the outcomes of patients treated for intermediate-and high-risk prostate cancer with a single schedule of either external beam radiation therapy (EBRT) and high-dose-rate brachytherapy (HDRB) boost or EBRT alone.Methods and Materials: From 2001-2006, 344 patients received EBRT with HDRB boost for definitive treatment of intermediate-or high-risk prostate cancer. The prescribed EBRT dose was 46 Gy in 23 fractions, with a HDR boost of 19.5 Gy in 3 fractions. This cohort was compared to a contemporaneously treated cohort who received EBRT to 74 Gy in 37 fractions, using a matched pair analysis. Three-dimensional conformal EBRT was used. Matching was performed using a propensity score matching technique. High-risk patients constituted 41% of the matched cohorts. Five-year clinical and biochemical outcomes were analyzed.Results: Initial significant differences in prognostic indicators between the unmatched treatment cohorts were rendered negligible after matching, providing a total of 688 patients. Median biochemical follow-up was 60.5 months. The 5-year freedom from biochemical failure was 79.8% (95% confidence interval [CI], 74.3%-85.0%) and 70.9% (95% CI, 65.4%-76.0%) for the HDRB and EBRT groups, respectively, equating to a hazard ratio of 0.59 (95% CI, 0.43-0.81, P=.0011). Interaction analyses showed no alteration in HDR efficacy when planned androgen deprivation therapy was administered (P=.95), but a strong trend toward reduced efficacy was shown compared to EBRT in high-risk cases (P=.06). Rates of grade 3 urethral stricture were 0.3% (95% CI, 0%-0.9%) and 11.8% (95% CI, 8.1%-16.5%) for EBRT and HDRB, respectively (P