Kestin L L, Martinez A A, Stromberg J S, Edmundson G K, Gustafson G S, Brabbins D S, Chen P Y, Vicini F A
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA.
J Clin Oncol. 2000 Aug;18(15):2869-80. doi: 10.1200/JCO.2000.18.15.2869.
We performed a matched-pair analysis to compare our institution's experience in treating locally advanced prostate cancer with external-beam radiation therapy (EBRT) alone to EBRT in combination with conformal interstitial high-dose-rate (HDR) brachytherapy boosts (EBRT + HDR).
From 1991 to 1998, 161 patients with locally advanced prostate cancer were prospectively treated with EBRT + HDR at William Beaumont Hospital, Royal Oak, Michigan. Patients with any of the following characteristics were eligible for study entry: pretreatment prostate-specific antigen (PSA) level of >/= 10.0 ng/mL, Gleason score >/= 7, or clinical stage T2b to T3c. Pelvic EBRT (46.0 Gy) was supplemented with three (1991 through 1995) or two (1995 through 1998) ultrasound-guided transperineal interstitial iridium-192 HDR implants. The brachytherapy dose was escalated from 5.50 to 10.50 Gy per implant. Each of the 161 EBRT + HDR patients was randomly matched with a unique EBRT-alone patient. Patients were matched according to PSA level, Gleason score, T stage, and follow-up duration. The median PSA follow-up was 2.5 years for both EBRT + HDR and EBRT alone.
EBRT + HDR patients demonstrated significantly lower PSA nadir levels (median, 0.4 ng/mL) compared with those receiving EBRT alone (median, 1.1 ng/mL). The 5-year biochemical control rates for EBRT + HDR versus EBRT-alone patients were 67% versus 44%, respectively (P <.001). On multivariate analyses, pretreatment PSA, Gleason score, T stage, and the use of EBRT alone were significantly associated with biochemical failure. Those patients in both treatment groups who experienced biochemical failure had a lower 5-year cause-specific survival rate than patients who were biochemically controlled (84% v 100%; P <.001).
Locally advanced prostate cancer patients treated with EBRT + HDR demonstrate improved biochemical control compared with those who are treated with conventional doses of EBRT alone.
我们进行了一项配对分析，以比较本机构单纯采用外照射放疗（EBRT）与采用EBRT联合适形组织间高剂量率（HDR）近距离放疗增敏（EBRT + HDR）治疗局部晚期前列腺癌的经验。
1991年至1998年期间，密歇根州皇家橡树市威廉·博蒙特医院对161例局部晚期前列腺癌患者进行了前瞻性的EBRT + HDR治疗。具有以下任何特征的患者均符合研究入组条件：治疗前前列腺特异性抗原（PSA）水平≥10.0 ng/mL、 Gleason评分≥7或临床分期为T2b至T3c。盆腔EBRT（46.0 Gy）辅以三次（1991年至1995年）或两次（1995年至1998年）超声引导下经会阴组织间铱-192 HDR植入。近距离放疗剂量从每次植入5.50 Gy逐步增加至10.50 Gy。161例EBRT + HDR患者中的每一位都与一位单独接受EBRT治疗的患者进行随机配对。根据PSA水平、Gleason评分、T分期和随访时间对患者进行配对。EBRT + HDR组和单纯EBRT组的PSA中位随访时间均为2.5年。
与单纯接受EBRT治疗的患者（中位值为1.1 ng/mL）相比，EBRT + HDR组患者的PSA最低点水平显著更低（中位值为0.4 ng/mL）。EBRT + HDR组与单纯EBRT组患者的5年生化控制率分别为67%和44%（P <.001）。多因素分析显示，治疗前PSA、Gleason评分、T分期以及单纯使用EBRT与生化失败显著相关。两个治疗组中发生生化失败的患者的5年病因特异性生存率低于生化控制的患者（84%对100%；P <.001）。
与单纯采用传统剂量EBRT治疗的患者相比，采用EBRT + HDR治疗的局部晚期前列腺癌患者的生化控制得到改善。
