Results of high dose rate afterloading brachytherapy boost to conventional external beam radiation therapy for initial and locally advanced prostate cancer
Results of high dose rate afterloading brachytherapy boost to conventional external beam radiation therapy for initial and locally advanced prostate cancer
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DOI：
10.1016/s0167-8140(02)00408-5
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发表时间：
2003-02-01
影响因子：
5.7
通讯作者：
Ferrigno, R
中科院分区：
文献类型：
--
作者：
Pellizzon, ACA;Nadalin, W;Ferrigno, R
目的：评价作为常规外照射放射治疗（EBRT）的增强治疗，采用分次经直肠超声引导（TRUS）高剂量率后负荷近距离放射治疗（HDR-B）治疗的初始和局部晚期前列腺癌对生化控制（bNED）、急性和晚期胃肠（GI）和泌尿系统（GU）发病率的影响。患者和方法：从1997年3月至2000年2月，共有119名具有以下特征的患者有资格进入研究：活检证实的腺癌Gleason评分（GS），初始前列腺特异性抗原（PSA）水平剂量1992 AJCC临床分期T3 a或更低，前列腺体积< 60 cc。在HDR-B之前，所有患者均接受了EBRT 6 MV光子治疗，中位剂量为45戈伊，分次1.8戈伊，仅用于前列腺和精囊。使用Nucletron计划系统生成HDR-B治疗计划和剂量计算。根据生化失败的风险将患者分为两组：EBRT前无（LR）或有新辅助总雄激素剥夺（AD）的低风险组（LR + AD）和无（HR）或有新辅助AD的高风险组（HR + AD），用于bNED和剂量递增方案。LR包括表现为GS < 6、T1或T2 a和/或初始PSA < 10 ng/ml的患者，其接受16戈伊（4戈伊分次，b.i.d.）人类发展报告-B。其余患者被分组为HR或HR + AD，并接受20戈伊（5戈伊剂量，每日两次）人类发展报告-B。使用标准几何优化来优化规划。分别使用1.5和3戈伊的u/p比计算肿瘤控制和迟反应组织的生物有效剂量（BED）。他们匹配bNED，急性和晚期胃肠道（GI）和泌尿系统（GU）的发病率，根据RTOG/EORTC评分criteria.Results：患者的中位年龄为68岁（范围47-83），中位随访时间为41个月（范围18-48）。所有患者48个月的粗生化和精算生化控制（bNED）分别为69.5%和75.3%。当分为LR、LR + AD、HR和HR + AD时，精算bNED分别为78.2%、76%、76%和72.3%（P = 0.89）。在自发消退的患者中，18.5%（20/108）和10.2%（11/108）的急性GU和GI发病率为G1-2。晚期GI和GU发病率G1-2分别见于12%（13/108）和4.6%（5/ 108）的患者，无需干预。结论：HDR-B有许多优点，但最重要的是在线剂量测定，质量控制和程序非常适形的能力。当用HDR-B作为EBRT的增强治疗初始和局部晚期前列腺癌时，GU和GI急性和晚期发病率较低，bNED可接受，但我们仍需要等待分析HDR-B和适形治疗的III期开放试验的结果。(C)2003爱思唯尔科学爱尔兰有限公司保留所有权利。
Purpose: To evaluate the impact on biochemical control (bNED), acute and late gastro-intestinal (GI) and urological(GU) morbidity of initial and locally advanced prostate cancer treated with fractionated transrectal ultrasound-guided (TRUS) high dose rate after loading brachytherapy (HDR-B) as a boost to conventional external beam radiation therapy (EBRT).Patients and methods: From March 1997 to February 2000 a total of 119 patients with any of the following characteristics were eligible for study entry: biopsy proven adenocarcinoma Gleason scored (GS), initial prostatic specific antigen (PSA) level dosage 1992 AJCC clinical stage T3a or less, and prostatic volume < 60 cc. All patients had prior to HDR-B a course of EBRT 6 MV photons to a median dose of 45 Gy, in 1.8 Gy fractions, to the prostate and seminal vesicles only. HDR-B treatment planning and dosimetric calculations were generated with the Nucletron Planning System. Patients were grouped into two groups, according to their risk for biochemical failure: low-risk group without (LR) or with neoadjuvant total androgen deprivation (AD) prior to EBRT (LR + AD) and high-risk group without (HR) or with neoadjuvant AD (HR + AD), for bNED and dose-escalation protocol. LR encompassed patients who presented GS < 6, T1 or T2a and or initial PSA < 10 ng/ml, who were treated with 16 Gy (4 Gy fractions, b.i.d.) HDR-B. The remaining patients were grouped into HR or HR + AD and received 20 Gy (5 Gy fractions, b.i.d.) HDR-B. The planning was optimized using the standard geometric optimization. Biological effective doses (BED) for tumor control and late responding tissue were calculated using a u/p ratio of 1.5 and 3 Gy, respectively. They were matched with bNED, acute and late gastrointestinal (GI) and urological (GU) morbidity, according to the RTOG/EORTC scoring criteria.Results: Median age of patients was 68 years (range 47-83), with a median follow-up of 41 months (range 18-48). The crude and actuarial biochemical controls (bNED) in 48 months for all patients were 69.5 and 75.3%, respectively. When grouped into LR, LR + AD, HR and HR + AD the actuarial bNED were 78.2, 76, 76 and 72.3% (P = 0.89), respectively. Acute GU and GI morbidity G1-2 were seen in 18.5% (20/108) and 10.2% (11/108) of patients with spontaneous regression. Late GI and GU morbidity G1-2 were seen in 12% (13/108) and 4.6 (5/ 108) of patients, with no need of intervention. No acute or late G3-4 GU or GI morbidity was seen.Conclusions: There are many advantages in HDR-B, but the most important ones are the capability of on-line 2dosimetry, quality control and the procedure being very conformal. There is a low incidence of GU and GI acute and late morbidity with acceptable bNED when treating initial and locally advanced prostate cancer with HDR-B as a boost to EBRT, but we still need to wait for results of phase III open trials that analyze HDR-B and conformal therapy. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.