The emerging role of high-dose-rate (HDR) brachytherapy as monotherapy for prostate cancer

被引:36
|
作者
Yoshioka, Yasuo [1 ]
Yoshida, Ken [2 ]
Yamazaki, Hideya [3 ]
Nonomura, Norio [4 ]
Ogawa, Kazuhiko [1 ]
机构
[1] Osaka Univ, Grad Sch Med, Dept Radiat Oncol, Suita, Osaka 5650871, Japan
[2] Osaka Med Coll, Dept Radiol, Takatsuki, Osaka 5698686, Japan
[3] Kyoto Prefectural Univ Med, Dept Radiol, Kamigyo Ku, Kyoto 6028566, Japan
[4] Osaka Univ, Grad Sch Med, Dept Urol, Suita, Osaka 5650871, Japan
基金
日本学术振兴会;
关键词
prostate cancer; high-dose-rate (HDR); brachytherapy; monotherapy; hypofractionation; RATE INTERSTITIAL BRACHYTHERAPY; RATE AFTERLOADING BRACHYTHERAPY; RADIATION-THERAPY; CATHETER MOVEMENT; PHASE-II; EXTREME HYPOFRACTIONATION; ANDROGEN SUPPRESSION; FEASIBILITY REPORT; ALPHA/BETA RATIO; HIGH-RISK;
D O I
10.1093/jrr/rrt027
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
High-dose-rate (HDR) brachytherapy as monotherapy is a comparatively new brachytherapy procedure for prostate cancer. In addition to the intrinsic advantages of brachytherapy, including radiation dose concentration to the tumor and rapid dose fall-off at the surrounding normal tissue, HDR brachytherapy can yield a more homogeneous and conformal dose distribution through image-based decisions for source dwell positions and by optimization of individual source dwell times. Indication can be extended even to T3a/b or a part of T4 tumors because the applicators can be positioned at the extracapsular lesion, into the seminal vesicles, and/or into the bladder, without any risk of source migration or dropping out. Unlike external beam radiotherapy, with HDR brachytherapy inter-/intra-fraction organ motion is not problematic. However, HDR monotherapy requires patients to stay in bed for 1-4 days during hospitalization, even though the actual overall treatment time is short. Recent findings that the alpha/beta value for prostate cancer is less than that for the surrounding late-responding normal tissue has made hypofractionation attractive, and HDR monotherapy can maximize this advantage of hypofractionation. Research on HDR monotherapy is accelerating, with a growing number of publications reporting excellent preliminary clinical results due to the high 'biologically effective dose (BED)' of >200 Gy. Moreover, the findings obtained for HDR monotherapy as an early model of extreme hypofractionation tend to be applied to other radiotherapy techniques such as stereotactic radiotherapy. All these developments point to the emerging role of HDR brachytherapy as monotherapy for prostate cancer.
引用
收藏
页码:781 / 788
页数:8
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