JAMA network open · 2026
SBRT vs HDR Brachytherapy for Intermediate-Risk Prostate Cancer.
СтатьяСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Udovicich Cristian, Cheung Patrick, Chu William, Chung Hans, Detsky Jay, Liu Stanley, Morton Gerard, Tseng Chia-Lin, Vesprini Danny, Hudson John M, Ong Wee Loon, Kennedy Thomas, Helou Joelle, Davidson Melanie, Ravi Ananth, McGuffin Merrylee, Zhang Liying, Mamedov Alexandre, Deabreu Andrea, Kulasingham-Poon Meghan, Loblaw Andrew
Аннотация
IMPORTANCE: Stereotactic body radiotherapy (SBRT) and high-dose-rate brachytherapy monotherapy (HDR-BT) are options for intermediate-risk prostate cancer. However, no prospective evidence is available to compare these modalities.
OBJECTIVE: To compare the biochemical failure (BCF), late patient-reported quality of life (PR-QoL), and acute and late adverse events (AEs) associated with SBRT and HDR-BT using prospective data.
DATA SOURCES: This was an individual patient data post hoc pooled analysis of 5 prospective trials with recruitment from 2010 to 2018. Statistical analyses were performed in September 2024.
STUDY SELECTION: This was a post hoc analysis of these 5 sprospective trials. Eligibility criteria comprised men with intermediate-risk prostate cancer undergoing 5- or 2-fraction SBRT or 2-fraction HDR-BT. No androgen deprivation therapy was permitted.
DATA EXTRACTION AND SYNTHESIS: Baseline patient and clinicopathological characteristics were requested.
MAIN OUTCOMES AND MEASURES: BCF, a minimal clinically important change on the PR-QoL, and clinician-reported AEs were the main outcomes.
RESULTS: After a median (IQR) follow-up of 9.5 (5.5-10.6) years, 247 men met the eligibility criteria, including 180 men undergoing SBRT (72.8%; mean [SD] age, 69.5 [6.7] years) and 67 men undergoing HDR-BT (27.1%; mean [SD] age, 66.0 [6.5] years). HDR-BT was associated with increased BCF. At 5 years, BCF was 7.8% (95% CI, 1.0%-14.6%) for HDR compared with 3.0% (95% CI, 0.4%-5.6%) for SBRT. At 10 years, BCF was 38.0% (95% CI, 19.8%-56.1%) for HDR compared with 10.4% (95% CI, 4.3%-16.6%) for SBRT (P < .001). The HDR-BT cohort had a significantly higher incidence of acute grade 2 or greater genitourinary AEs compared with SBRT (50 men [74.6%] vs 31 men [51.7%]; P = .007). There were no significant differences in any other acute or late AEs or late PR-QoL.
CONCLUSIONS AND RELEVANCE: This post hoc pooled analysis reports a long-term comparison of SBRT and HDR-BT using prospective data. SBRT had significantly lower BCF and acute genitourinary AEs, and there was no significant difference in late PR-QoL.
OBJECTIVE: To compare the biochemical failure (BCF), late patient-reported quality of life (PR-QoL), and acute and late adverse events (AEs) associated with SBRT and HDR-BT using prospective data.
DATA SOURCES: This was an individual patient data post hoc pooled analysis of 5 prospective trials with recruitment from 2010 to 2018. Statistical analyses were performed in September 2024.
STUDY SELECTION: This was a post hoc analysis of these 5 sprospective trials. Eligibility criteria comprised men with intermediate-risk prostate cancer undergoing 5- or 2-fraction SBRT or 2-fraction HDR-BT. No androgen deprivation therapy was permitted.
DATA EXTRACTION AND SYNTHESIS: Baseline patient and clinicopathological characteristics were requested.
MAIN OUTCOMES AND MEASURES: BCF, a minimal clinically important change on the PR-QoL, and clinician-reported AEs were the main outcomes.
RESULTS: After a median (IQR) follow-up of 9.5 (5.5-10.6) years, 247 men met the eligibility criteria, including 180 men undergoing SBRT (72.8%; mean [SD] age, 69.5 [6.7] years) and 67 men undergoing HDR-BT (27.1%; mean [SD] age, 66.0 [6.5] years). HDR-BT was associated with increased BCF. At 5 years, BCF was 7.8% (95% CI, 1.0%-14.6%) for HDR compared with 3.0% (95% CI, 0.4%-5.6%) for SBRT. At 10 years, BCF was 38.0% (95% CI, 19.8%-56.1%) for HDR compared with 10.4% (95% CI, 4.3%-16.6%) for SBRT (P < .001). The HDR-BT cohort had a significantly higher incidence of acute grade 2 or greater genitourinary AEs compared with SBRT (50 men [74.6%] vs 31 men [51.7%]; P = .007). There were no significant differences in any other acute or late AEs or late PR-QoL.
CONCLUSIONS AND RELEVANCE: This post hoc pooled analysis reports a long-term comparison of SBRT and HDR-BT using prospective data. SBRT had significantly lower BCF and acute genitourinary AEs, and there was no significant difference in late PR-QoL.