目的:我们回顾性研究了低剂量率近距离放射治疗(LDR-BT)的生物学有效剂量(BED)的效果及其与雄激素剥夺治疗(ADT)在LDR-BT治疗中危前列腺癌(PCa)期间的可能相互作用。
方法:共693例患者,中等风险PCa,谁接受了LDR-BT有或没有补充外束放疗,包括在这项研究中。我们根据BED将患者分为两组(<180Gy2,低BED组;≥180Gy2,高BED组),并评估ADT持续时间对每组肿瘤结局的影响。
结果:总计,431例患者接受BED≥180Gy2。在非ADT之间观察到生化无复发生存期(BCRFS)和临床无进展生存期(CPFS)的显着差异,ADT≤3个月,和ADT>3个月亚组较低的BED组(分别为p=0.005和0.049)。然而,在较高的BED组中,BCRFS或CPFS没有检测到显著差异(分别为p=0.63和0.76).低BED组BCR和CP的多变量分析显示,随着ADT持续时间的增加,BCRFS(趋势p=0.001)和CPFS(趋势p=0.015)率呈显着下降趋势,这与有利的结果有关。然而,在较高BED组,BCRFS或CPFS率没有观察到显著趋势.
结论:适当的局部放射剂量可提供良好的肿瘤学结果,并可能减少长期ADT的需要。
OBJECTIVE: We retrospectively investigated the effect of a biologically effective dose (BED) of Low-dose rate brachytherapy (LDR-BT) and its possible interaction with androgen deprivation therapy (ADT) during LDR-BT treatment for intermediate-risk prostate cancer (PCa).
METHODS: A total of 693 patients with localized, intermediate-risk PCa, who underwent LDR-BT with or without supplemental external beam radiotherapy, were included in this study. We stratified patients into two groups according to BED (<180 Gy2, lower BED group; ≥180 Gy2, higher BED group) and evaluated the effect of ADT duration on the oncological outcomes of each group.
RESULTS: In total, 431 patients received BED ≥180 Gy2. Significant differences in biochemical recurrence-free survival (BCRFS) and clinical progression-free survival (CPFS) were observed among the non-ADT, ADT ≤3 months, and ADT >3 months subgroups of the lower BED group (p=0.005 and 0.049, respectively). However, no significant differences in BCRFS or CPFS were detected in the higher BED group (p=0.63 and 0.76, respectively). Multivariate analysis of BCR and CP in the lower BED group revealed a significant decreasing trend in the BCRFS (p for trend=0.001) and CPFS rates (p for trend=0.015) as ADT duration increased, which was associated with favorable outcomes. However, no significant trend was observed in the BCRFS or CPFS rate in the higher BED group.
CONCLUSIONS: An adequate local radiation dose provides favorable oncological outcomes and could potentially reduce the need for long-term ADT.