High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term androgen deprivation therapy for very high-risk prostate cancer
High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term androgen deprivation therapy for very high-risk prostate cancer
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DOI：
10.1111/iju.14305
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发表时间：
2020-07-07
影响因子：
2.6
通讯作者：
Tomita, Yoshihiko
中科院分区：
文献类型：
--
作者：
Kasahara, Takashi;Ishizaki, Fumio;Tomita, Yoshihiko
目的评价高剂量率近距离放疗联合低分割外束放疗治疗被美国国家癌症综合网络列为高危的前列腺癌患者的疗效。方法2009年6月至2015年9月，66例符合高危疾病标准的患者接受高剂量率近距离放疗（2次/ 9 Gy），作为外束放疗（13次/ 3 Gy）的补充。雄激素剥夺治疗持续约3年。使用Phoenix定义评估生化失败。结果中位随访时间为放疗结束后53个月。5年生化无失败、无远处转移、前列腺癌特异性和总生存率分别为88.7、89.2、98.5和97.0%。在多变量模型中评估了非常高风险标准的每个组成部分的独立贡献。原发性Gleason模式5与生化失败（P = 0.017）和远处转移（P = 0.049）的风险增加相关，而临床分期>= T3b或>4活检核（Gleason评分为8-10）对这两个结果没有显著影响。2例（3.0%）患者出现3级泌尿生殖系统毒性，而未发生>= 3级胃肠道毒性。结论：目前的研究表明，这种多模式方法提供了潜在的良好的癌症控制和可接受的高危疾病相关发病率。原发性Gleason 5型患者预后不良的风险较高，这表明在这些病例中需要更积极的治疗方法。
Objective To estimate the outcomes of high-dose-rate brachytherapy combined with hypofractionated external beam radiotherapy in prostate cancer patients classified as very high risk by the National Comprehensive Cancer Network. Methods Between June 2009 and September 2015, 66 patients meeting the criteria for very high-risk disease received high-dose-rate brachytherapy (2 fractions of 9 Gy) as a boost of external beam radiotherapy (13 fractions of 3 Gy). Androgen deprivation therapy was administered for approximately 3 years. Biochemical failure was assessed using the Phoenix definition. Results The median follow-up period was 53 months from the completion of radiotherapy. The 5-year biochemical failure-free, distant metastasis-free, prostate cancer-specific and overall survival rates were 88.7, 89.2, 98.5 and 97.0%, respectively. The independent contribution of each component of the very high-risk criteria was assessed in multivariable models. Primary Gleason pattern 5 was associated with increased risks of biochemical failure (P = 0.017) and distant metastasis (P = 0.049), whereas clinical stage >= T3b or >4 biopsy cores with Gleason score 8-10 had no significant impact on the two outcomes. Grade 3 genitourinary toxicities were observed in two (3.0%) patients, whereas no grade >= 3 gastrointestinal toxicities occurred. Conclusions The present study shows that this multimodal approach provides potentially excellent cancer control and acceptable associated morbidity for very high-risk disease. Patients with primary Gleason pattern 5 are at a higher risk of poor outcomes, indicating the need for more aggressive approaches in these cases.