Kovács G, Galalae R, Loch T, Rzehak P, Wilhelm R, Bertermann H, Nürnberg N, Kohr P, Kimmig B
Interdisziplinäres Brachytherapiezentrum, Klinik für Strahlentherapie und Radioonkologie, Kiel.
Praxis (Bern 1994). 2001 Sep 20;90(38):1617-22.
To evaluate a new therapy protocol for local dose escalation by high dose rate (HDR) brachytherapy for survival, morbidity and prognostic variables in men with localized prostate cancer. The prospectively recorded files of 189 men aged in median 69 years with a mean follow-up of 6 years (12-143 months) receiving curatively intended combined high dose rate (HDR) 192-iridium-brachytherapy (BT) and external beam radiation (EBR) for locally confined prostate cancer were analyzed. Mean age was 68.2 (range 44-84 years). Hundred and twenty-seven patients had T1-2 tumors, and 62 patients had T3-tumors. The total planned dose applied by external beam radiation was 50 Gy in the pelvis, and 40 Gy in the prostate by in-field-dose modification. The HDR-brachytherapy was delivered in two fractions. The dose per fraction amounted 15 Gy. Mean survival was 6 years (range 12-143 months), 76.7% of the patients survived and 86.3% were disease-free. The biochemical non-evidence of disease rate (BNED) was 78%. Univariate survival analysis revealed that low stage (T1-2), low grade (G1-2), normal PSA status after radiation therapy, and no adjuvant hormonal treatment were associated with long survival. However, the stratification for adjuvant hormonal treatment was not according to random. In multivariate analyses PSA status was an independent prognostic factor. The six year results confirm that local dose escalation by HDR-brachytherapy and external beam radiation is curative in men with locally confined prostate cancer. The results are especially in high risk patients encouraging.
评估高剂量率（HDR）近距离放射治疗局部剂量递增的新治疗方案对局限性前列腺癌男性患者的生存率、发病率和预后变量的影响。分析了189名年龄中位数为69岁的男性患者的前瞻性记录文件，这些患者接受了旨在治愈的高剂量率（HDR）铱-192近距离放射治疗（BT）和外照射放疗（EBR）联合治疗局限性前列腺癌，平均随访6年（12 - 143个月）。平均年龄为68.2岁（范围44 - 84岁）。127例患者为T1 - 2期肿瘤，62例患者为T3期肿瘤。外照射放疗的总计划剂量为盆腔50 Gy，通过野内剂量调整前列腺区为40 Gy。HDR近距离放射治疗分两次进行。每次剂量为15 Gy。平均生存期为6年（范围12 - 143个月），76.7%的患者存活，86.3%无疾病。生化无疾病证据率（BNED）为78%。单因素生存分析显示，低分期（T1 - 2）、低分级（G1 - 2）、放疗后PSA状态正常以及未接受辅助激素治疗与长期生存相关。然而，辅助激素治疗的分层并非随机。多因素分析中，PSA状态是独立的预后因素。六年的结果证实，HDR近距离放射治疗和外照射放疗局部剂量递增对局限性前列腺癌男性患者具有治愈性。这些结果对高危患者尤其鼓舞人心。
