疾病及治疗相关因素对前列腺近距离放射治疗后活检结果的影响：对治疗优化的启示

The effect of disease and treatment-related factors on biopsy results after prostate brachytherapy: implications for treatment optimization.

作者信息

Stock R G, Stone N N, Kao J, Iannuzzi C, Unger P

机构信息

Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York, USA.

出版信息

Cancer. 2000 Oct 15;89(8):1829-34. doi: 10.1002/1097-0142(20001015)89:8<1829::aid-cncr25>3.0.co;2-9.

DOI:10.1002/1097-0142(20001015)89:8<1829::aid-cncr25>3.0.co;2-9

PMID:11042580

Abstract

BACKGROUND

Posttreatment prostate biopsy is a method of assessing local control after irradiation for prostate carcinoma. An analysis of the effect of disease- and treatment-related factors on biopsy results after prostate brachytherapy was performed to aid in patient selection and treatment optimization.

METHODS

Two hundred sixty-eight patients underwent posttreatment prostate biopsy (6-8 cores) 2 years after brachytherapy alone without external beam irradiation. Follow-up ranged from 24 to 111 months (median, 43 months). Implants were performed using a real-time ultrasound guided technique with the isotopes (125)I in 186 and (103)Pd in 82 patients. Ninety-eight patients underwent hormonal therapy (HT) 3 months before and 2-3 months after implant. Implant dose was defined as the D90 (dose delivered to 90% of the gland from the dose volume histogram generated using 1-month computed tomography-based dosimetry).

RESULTS

Overall, 89% of patients (238 of 268) had negative biopsies. A positive biopsy was a predictor of biochemical failure. Patients with a positive biopsy had a 5-year freedom from biochemical failure of 40% versus 76% for patients with a negative biopsy (P = 0.0003). Univariate and multivariate analysis found that risk group, HT, and implant dose significantly affected biopsy outcome. Patients with low risk features (prostate specific antigen [PSA] </= 10 ng/mL; Gleason score </= 6; and classification T2a or lower) (n = 104) had a negative biopsy rate of 95% versus 85% for those with high risk features (PSA > 10 ng/mL or Gleason score >/= 7 or classification T2b or higher) (n = 164) (P = 0.008). Hormonal therapy was associated with a negative biopsy rate of 98% versus 84% for implant alone (P = 0.003). Patients receiving a high implant dose (D90 >/= 140 grays [Gy] for (125)I or >/= 100 Gy for (103)Pd) (n = 174) had a negative biopsy rate of 95% versus 77% for those receiving a low dose (D90 < 140 Gy for (125)I or < 100 Gy for (103)Pd) (n = 87; P < 0.001).

CONCLUSIONS

Biopsy results support the use of brachytherapy without external beam irradiation for patients with low risk features and highlight the importance of achieving an adequate implant dose.

摘要

背景

治疗后前列腺活检是评估前列腺癌放疗后局部控制情况的一种方法。对前列腺近距离放射治疗后疾病和治疗相关因素对活检结果的影响进行分析，以辅助患者选择和优化治疗方案。

方法

268例患者在仅接受近距离放射治疗而未接受外照射放疗2年后接受了治疗后前列腺活检（6 - 8针）。随访时间为24至111个月（中位时间为43个月）。采用实时超声引导技术进行植入，186例患者使用同位素碘-125，82例患者使用钯-103。98例患者在植入前3个月和植入后2 - 3个月接受了激素治疗（HT）。植入剂量定义为D90（根据基于1个月计算机断层扫描剂量测定生成的剂量体积直方图，给予腺体90%的剂量）。

结果

总体而言，89%的患者（268例中的238例）活检结果为阴性。活检阳性是生化失败的一个预测因素。活检阳性的患者5年无生化失败生存率为40%，而活检阴性的患者为76%（P = 0.0003）。单因素和多因素分析发现，风险组、激素治疗和植入剂量显著影响活检结果。低风险特征（前列腺特异性抗原[PSA]≤10 ng/mL；Gleason评分≤6；以及T2a期或更低分期）的患者（n = 104）活检阴性率为95%，而高风险特征（PSA>10 ng/mL或Gleason评分≥7或T2b期或更高分期）的患者（n = 164）活检阴性率为85%（P = 0.008）。激素治疗组活检阴性率为98%，而单纯植入组为84%（P = 0.003）。接受高植入剂量（碘-125的D90≥140戈瑞[Gy]或钯-103的D90≥100 Gy）的患者（n = 174）活检阴性率为95%，而接受低剂量（碘-125的D90<l40 Gy或钯-103的D90<100 Gy）的患者（n = 87；P<0.001）活检阴性率为77%。