Ragde H, Korb L J, Elgamal A A, Grado G L, Nadir B S
Northwest Prostate Institute, Seattle, Washington 98133, USA.
Cancer. 2000 Jul 1;89(1):135-41.
The purported lack of long term modern prostate brachytherapy outcome data continues to lead many physicians to recommend other, more traditional treatments. This concern for long term results has encouraged the authors to supplement their earlier 10-year follow-up of patients receiving brachytherapy; in the process, an additional 77 patients (> 50%) were added to the original cohort, and the follow-up time was increased by 2 years.
Between January 1987 and September 1989, 229 patients with T1-T3 prostate carcinoma underwent transperineal prostate brachytherapy using iodine-125 (I-125). No patient received adjuvant hormone therapy. The median Gleason sum was 5 (range, 2-10). Of these patients, 147 were determined to have a high probability of organ-confined disease and were treated solely with an I-125 implant. The remaining 82 patients were determined to be at increased risk for extracapsular disease and received pelvic external beam radiation in addition to brachytherapy. All patients were followed continuously. Failure was defined as a positive biopsy, radiographic evidence of metastases, or three consecutive rises in prostate specific antigen (PSA) levels as defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus article.
Excluding deaths from intercurrent disease, the median follow-up was 122 months (range, 18-144 months). Fourteen patients were excluded from analysis due to insufficient follow-up. Adopting the ASTRO definition of failure resulted in minimal change in survival when compared with the authors' previous study, which used a PSA level > 0.5 ng/mL as the failure point. Observed 10-year disease free survival (DFS) for the entire cohort was 70%. In the brachytherapy only group, the observed 10-year DFS was 66%, whereas those patients treated with the addition of external pelvic radiation achieved a DFS of 79%. None of the patients who were followed for the full 12 years failed between Years 10 and 12. Only 25% of the failures observed occurred > 5 years after treatment, thus confirming the durability of brachytherapy.
Prostate brachytherapy provides excellent long term disease control with few late failures reported in the authors' program. The addition of external beam radiation appears to confer survival advantages in selected patients. Using the ASTRO failure criteria for long term follow-up resulted in no significant difference compared with using a PSA failure point of 0.5 ng/mL.
所谓缺乏现代前列腺近距离放射治疗的长期结果数据，仍致使许多医生推荐其他更传统的治疗方法。对长期结果的担忧促使作者补充其对接受近距离放射治疗患者的早期10年随访；在此过程中，在原始队列中增加了77名患者（超过50%），随访时间延长了2年。
1987年1月至1989年9月期间，229例T1 - T3期前列腺癌患者接受了经会阴前列腺碘 - 125（I - 125）近距离放射治疗。没有患者接受辅助激素治疗。Gleason评分中位数为5（范围2 - 10）。在这些患者中，147例被确定为器官局限性疾病高概率患者，仅接受I - 125植入治疗。其余82例患者被确定为包膜外疾病风险增加，除近距离放射治疗外还接受了盆腔外照射放疗。所有患者均接受连续随访。失败定义为活检阳性、转移的影像学证据或根据美国放射肿瘤学会（ASTRO）共识文章定义的前列腺特异性抗原（PSA）水平连续三次升高。
排除并发疾病导致的死亡，中位随访时间为122个月（范围18 - 144个月）。14例患者因随访不足被排除在分析之外。与作者之前使用PSA水平>0.5 ng/mL作为失败点的研究相比，采用ASTRO失败定义导致生存率变化极小。整个队列观察到的10年无病生存率（DFS）为70%。仅接受近距离放射治疗的组中，观察到的10年DFS为66%，而那些接受盆腔外照射放疗的患者DFS达到79%。随访满12年的患者在第10年至第12年期间均未出现失败。观察到的失败病例中只有25%发生在治疗后5年以上，从而证实了近距离放射治疗的持久性。
前列腺近距离放射治疗能提供出色的长期疾病控制，作者的治疗方案中报告的晚期失败病例很少。盆腔外照射放疗的加入似乎在部分患者中带来生存优势。使用ASTRO失败标准进行长期随访与使用PSA失败点0.5 ng/mL相比无显著差异。
