Merrick Gregory S, Wallner Kent E, Butler Wayne M
Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia, USA.
J Urol. 2003 May;169(5):1643-52. doi: 10.1097/01.ju.0000035544.25483.61.
We summarize the permanent prostate brachytherapy literature, including biochemical outcomes, quality of life parameters and areas of controversy.
The permanent prostate brachytherapy literature was reviewed using MEDLINE searches to ensure completeness.
Using various planning and intraoperative techniques the majority of the brachytherapy literature demonstrates durable biochemical outcomes for patients with low, intermediate and high risk features. For low risk patients there is no advantage to combining supplemental external beam radiation therapy with brachytherapy. In addition, supplemental external beam radiation therapy may not improve biochemical outcomes for patients at intermediate and high risk if the target volume consists of the prostate with a generous periprostatic margin. There is no defined role for adjuvant hormonal manipulation. Although a reliable set of pretreatment criteria to predict implant related morbidity is not available, severe urinary and rectal morbidity is rare. The incidence of brachytherapy induced erectile dysfunction is significantly greater than initially reported but the majority of patients respond favorably to sildenafil.
Continued refinements in brachytherapy planning and implementation techniques, postimplantation evaluation and continued elucidation of the etiology of urinary, bowel and sexual dysfunction should result in further improvements in biochemical and quality of life outcomes.
我们总结永久性前列腺近距离放射治疗的文献，包括生化结果、生活质量参数及争议领域。
通过检索MEDLINE对永久性前列腺近距离放射治疗的文献进行综述，以确保完整性。
运用各种计划和术中技术，大多数近距离放射治疗文献表明，对于低、中、高风险特征的患者，其生化结果持久。对于低风险患者，将补充性外照射放疗与近距离放射治疗联合并无优势。此外，如果靶体积包括带有宽周边前列腺边缘的前列腺，补充性外照射放疗可能无法改善中、高风险患者的生化结果。辅助性激素治疗尚无明确作用。虽然尚无一套可靠的预测植入相关并发症的预处理标准，但严重的泌尿和直肠并发症罕见。近距离放射治疗所致勃起功能障碍的发生率显著高于最初报道，但大多数患者对西地那非反应良好。
在近距离放射治疗计划和实施技术、植入后评估方面持续改进，以及对泌尿、肠道和性功能障碍病因的持续阐明，应会使生化结果和生活质量进一步改善。
