Two-fraction stereotactic ablative radiotherapy (SABR) versus two-fraction high dose rate (HDR) brachytherapy for localized prostate cancer: Does dose heterogeneity matter?

被引:10
作者
Correa, Rohann J. M. [1 ,2 ]
Morton, Gerard [1 ,2 ]
Chung, Hans T. [1 ,2 ]
Tseng, Chia-Lin [1 ,2 ]
Cheung, Patrick [1 ,2 ]
Chu, William [1 ,2 ]
Liu, Stanley K. [1 ,2 ]
McGuffin, Merrylee [1 ,2 ]
Shahid, Anam [1 ]
Davidson, Melanie [1 ,2 ]
Ravi, Ananth [3 ]
Helou, Joelle [2 ,4 ]
Alayed, Yasir [1 ,5 ]
Zhang, Liying [1 ]
Mamedov, Alexandre [1 ]
Loblaw, Andrew [1 ,2 ,6 ]
机构
[1] Sunnybrook Hlth Sci Ctr, Odette Canc Ctr, Toronto, ON, Canada
[2] Univ Toronto, Dept Radiat Oncol, Toronto, ON, Canada
[3] Univ Toronto, Molli Surg, Princess Margaret Canc Ctr, Toronto, ON, Canada
[4] Univ Toronto, Dept Radiat Oncol, Princess Margaret Canc Ctr, Toronto, ON, Canada
[5] King Saud Univ, Coll Med, Radiat Oncol, Riyadh, Saudi Arabia
[6] Univ Toronto, Dept Hlth Policy Measurement & Evaluat, Toronto, ON, Canada
关键词
Prostate cancer; Stereotactic body radiotherapy; HDR monotherapy; QOL; RADIATION-THERAPY; RATE MONOTHERAPY; INTERMEDIATE; FRACTIONS;
D O I
10.1016/j.radonc.2022.02.007
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background and purpose: Contemporary radiotherapy for localized prostate cancer (PCa) is deliverable via stereotactic ablative radiotherapy (SABR) and high dose rate (HDR) brachytherapy. Here we report on a parallel cohort analysis of two prospective, phase II clinical trials of two-fraction prostate SABR versus two-fraction HDR monotherapy. Materials and methods: Enrolled patients had histologically-confirmed PCa (clinical stage T1c-T2b; grade group 1, 2, or 3; and PSA < 20 ng/mL). SABR and HDR doses were 26 Gy and 27 Gy in 2 weekly fractions, respectively. Patient-level data from each cohort was analysed to assess prostate specific antigen (PSA) response kinetics, biochemical failure, toxicity, and quality of life (QOL). Results: Thirty patients receiving SABR and 83 receiving HDR were included. Fifty percent and 30% of patients had unfavourable-intermediate risk disease, respectively. SABR patients had higher mean baseline PSA (8.7 versus 6.8 ng/mL, p = 0.016). Median follow-up was 72.7 and 65.3 months, respectively. Mean dose delivered (D-mean) was 26.6-26.8 Gy for SABR versus 35.5-45.5 Gy for HDR. Both cohorts achieved a median nadir PSA of 0.16 ng/mL at a median of 57 months post-treatment. Cumulative biochemical failure probability (+/- SE) at 72 months was 3.5% (+/- 3.5%) for SABR versus 12.8% (+/- 4.8%) for HDR (p = 0.19). Low rates of CTCAE grade >= 2 toxicity were observed in both cohorts. No differences in EPIC scores over time were observed between cohorts. Conclusions: Two-fraction SABR yields similar rates of biochemical failure, acute and late toxicities, and QOL as two-faction HDR brachytherapy. These data support the design of a randomized controlled trial comparing these treatments. (c) 2022 Elsevier B.V. All rights reserved.
引用
收藏
页码:51 / 56
页数:6
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