Dose escalation with external beam radiation therapy and high-dose-rate brachytherapy combined with long-term androgen deprivation therapy in high and very high risk prostate cancer: Comparison of two consecutive high-dose-rate schemes

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• 作者：Alicia Olarte¹ ; Mauricio Cambeiro¹ ; Marta Moreno-Jimé ; nez¹ ; ⁴ ; Leire Arbea¹ ; José ; Luis Pé ; rez-Gracia² ; Ignacio Gil-Bazo² ; Ignacio Pascual³ ; Javier Aristu¹ ; Rafael Martí ; nez-Monge¹ ; ^{rmartinezm@unav.es" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Prostate cancer ; High risk ; Androgen deprivation therapy ; 3DCRT ; HDR brachytherapy
• 刊名：Brachytherapy
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：15
• 期：2
• 页码：127-135
• 全文大小：272 K

文摘

To compare rectal toxicity, urinary toxicity, and nadir+2 PSA relapse-free survival (bRFS) in two consecutive Phase II protocols of high-dose-rate (HDR) brachytherapy used at the authors institution from 2001 to 2012.

Methods and Materials

Patients with National Comprehensive Cancer Network high risk and very high risk prostate cancer enrolled in studies HDR4 (2001–2007, n = 183) and HDR2 (2007–2012, n = 56) were analyzed. Patients received minipelvis external beam radiation therapy/intensity-modulated external radiotherapy to 54 Gy and 2 years of androgen blockade along with HDR brachytherapy. HDR4 protocol consisted of four 4.75 Gy fractions delivered in 48 hours; the HDR2 protocol delivered two 9.5 Gy fractions in 24 hours. Average 2-Gy equivalent dose (α/β = 1.2) prostate D₉₀ doses for the HDR4 and HDR2 groups were 89.8 Gy and 110.5 Gy, respectively (p = 0.0001). Both groups were well balanced regarding risk factors. Prior transurethral resection of the prostate was more frequent in the HDR2 group (p = 0.001).

Results

After a median followup of 7.4 years (range, 2–11.2), there was no difference in adverse grade ≥ 2 rectal events (HDR4 = 10.4% vs. HDR2 = 12.5%; p = ns) or grade ≥3 (HDR4 = 2.2% vs. HDR2 = 3.6%; p = ns). No differences in urinary grade ≥2 adverse events (HDR4 = 23% vs. HDR2 = 26.8%; p = ns) or grade ≥3 (HDR4 = 7.7% vs. HDR2 = 8.9%; p = ns) were detected. The 7-year bRFS for HDR4 and HDR2 protocols was 88.7% and 87.8%, respectively (p = ns).

Conclusions

HDR4 and HDR2 protocols produce similar results in terms of toxicity and bRFS at the intermediate time point of 7 years.