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  • [Cancer.] Long-term outcomes of partial prostate treatment with magnetic resonance imaging-guided brachytherapy for patients with favorable-risk prostate cancer.

    Brigham and Women’s Hospital / Martin T. King*

  • 출처
    Cancer.
  • 등재일
    2018 Sep 1
  • 저널이슈번호
    124(17):3528-3535. doi: 10.1002/cncr.31568. Epub 2018 Jul 5.
  • 내용

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    Abstract
    BACKGROUND:
    Partial prostate treatment has emerged as a potential method for treating patients with favorable-risk prostate cancer while minimizing toxicity. The authors previously demonstrated poor rates of biochemical disease control for patients with National Comprehensive Cancer Network (NCCN) intermediate-risk disease using partial gland treatment with brachytherapy. The objective of the current study was to estimate the rates of distant metastasis and prostate cancer-specific mortality (PCSM) for this cohort.

    METHODS:
    Between 1997 and 2007, a total of 354 men with clinical T1c disease, a prostate-specific antigen (PSA) level < 15 ng/mL, and Gleason grade ≤3 + 4 prostate cancer underwent partial prostate treatment with brachytherapy to the peripheral zone under 0.5-Tesla magnetic resonance guidance. The cumulative incidences of metastasis and PCSM for the NCCN very low-risk, low-risk, and intermediate-risk groups were estimated. Fine and Gray competing risk regression was used to evaluate clinical factors associated with time to metastasis.

    RESULTS:
    A total of 22 patients developed metastases at a median of 11.0 years (interquartile range, 6.9-13.9 years). The 12-year metastasis rates for patients with very low-risk, low-risk, and intermediate-risk disease were 0.8% (95% confidence interval [95% CI], 0.1%-4.4%), 8.7% (95% CI, 3.4%-17.2%), and 15.7% (95% CI, 5.7%-30.2%), respectively, and the 12-year PCSM estimates were 1.6% (95% CI, 0.1%-7.6%), 1.4% (95% CI, 0.1%-6.8%), and 8.2% (95% CI, 1.9%-20.7%), respectively. On multivariate analysis, NCCN risk category (low risk: hazard ratio, 6.34 [95% CI, 1.18-34.06; P = .03] and intermediate risk: hazard ratio, 6.98 [95% CI, 1.23-39.73; P = .03]) was found to be significantly associated with the time to metastasis.

    CONCLUSIONS:
    Partial prostate treatment with brachytherapy may be associated with higher rates of distant metastasis and PCSM for patients with intermediate-risk disease after long-term follow-up. Treatment of less than the full gland may not be appropriate for this cohort.

     


    Author information

    King MT1,2, Nguyen PL1,2, Boldbaatar N1, Tempany CM2,3, Cormack RA1,2, Beard CJ1,2, Hurwitz MD4, Suh WW5,6, D'Amico AV1,2, Orio PF 3rd1,2.
    1
    Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts.
    2
    Harvard Medical School, Boston, Massachusetts.
    3
    Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
    4
    Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
    5
    Department of Radiation Oncology, Ridley-Tree Cancer Center, Santa Barbara, California.
    6
    Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, California.

  • 키워드
    active surveillance; brachytherapy; intermediate risk; magnetic resonance-guided; partial
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