Beyer D C
Arizona Oncology Services, Scottsdale 85260, USA.
Urology. 1999 Nov;54(5):880-3. doi: 10.1016/s0090-4295(99)00241-1.
To determine the prostate-specific antigen (PSA)-based freedom from second failure, survival, and morbidity of permanent brachytherapy as salvage treatment for men for whom primary external beam irradiation of prostate cancer failed.
A retrospective review was performed on 17 consecutive men seen and treated with permanent brachytherapy for recurrent adenocarcinoma of the prostate from February 1989 to May 1994. Patients had been treated with a median of 63.3 Gy and presented with progressive local disease 23 to 146 months later (median 54). After a staging evaluation documenting no distant disease, all received permanent implantation of iodine-125 for 120 Gy (15 patients) or palladium-103 for 90 Gy (2 patients) using a transperineal ultrasound-guided technique. All doses were calculated before TG-43. Progression after brachytherapy was defined according to the ASTRO Consensus Conference definition. All results are reported as Kaplan-Meier actuarial 5-year results.
The 5-year actuarial freedom from second relapse was 53%. Both PSA and Gleason score appear to be prognostic factors, although both failed to reach statistical significance. Patients with a PSA 10 ng/mL or less at the time of salvage therapy had a freedom from second relapse rate of 67% compared with 25% for men with a PSA greater than 10 ng/mL (P = 0. 15). Those with low-grade tumor at the time of salvage therapy had an 83% freedom from second relapse rate compared with 30% for those with high-grade cancer (P = 0. 12). With 93% alive at 5 years, no significant difference was seen in survival on the basis of these prognostic groups. Acute and transient toxicity were readily managed and indistinguishable from that reported for previously unirradiated patients. Long-term complications were limited to a 24% risk of incontinence at 5 years.
Ultrasound-guided transperineal brachytherapy is an effective second-line therapy for patients for whom external beam irradiation has failed. Early intervention may be valuable when the PSA is less than 10 ng/mL. The risk of incontinence is significant, and patients must be individually counseled.
确定对于前列腺癌初次外照射失败的男性患者，采用永久性近距离放射疗法作为挽救性治疗时，基于前列腺特异性抗原（PSA）的无二次失败生存率、总生存率及发病率。
对1989年2月至1994年5月期间连续17例因复发性前列腺腺癌接受永久性近距离放射疗法的男性患者进行回顾性研究。患者接受的中位外照射剂量为63.3 Gy，在23至146个月后（中位时间54个月）出现局部疾病进展。在分期评估证明无远处转移后，所有患者均采用经会阴超声引导技术接受120 Gy碘-125永久性植入（15例患者）或90 Gy钯-103永久性植入（2例患者）。所有剂量均在TG-43之前计算得出。近距离放射治疗后的进展根据美国放射肿瘤学会（ASTRO）共识会议定义判定。所有结果均报告为Kaplan-Meier法计算的5年精算结果。
5年精算无二次复发率为53%。PSA和 Gleason评分似乎均为预后因素，尽管二者均未达到统计学显著性。挽救性治疗时PSA小于或等于10 ng/mL的患者无二次复发率为67%，而PSA大于10 ng/mL的患者为25%（P = 0.15）。挽救性治疗时为低级别肿瘤的患者无二次复发率为83%，而高级别癌症患者为30%（P = 0.12）。5年生存率为93%，基于这些预后分组的生存率未见显著差异。急性和短暂毒性易于处理，与先前未接受过照射的患者报告的情况无差异。长期并发症仅限于5年时有24%的尿失禁风险。
超声引导下经会阴近距离放射疗法是外照射失败患者的一种有效二线治疗方法。当PSA小于10 ng/mL时，早期干预可能有价值。尿失禁风险显著，必须对患者进行个体化咨询。
