Merrick Gregory S, Butler Wayne M, Wallner Kent E, Galbreath Robert W, Lief Jonathan H, Allen Zachariah, Adamovich Edward
Schiffler Cancer Center, Wheeling Hospital, Wheeling, WV 26003, USA.
Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):32-43. doi: 10.1016/j.ijrobp.2004.05.003.
To evaluate the impact of supplemental external beam radiotherapy (EBRT) and/or androgen deprivation therapy (ADT) on 8-year biochemical outcome after permanent prostate brachytherapy.
Between April 1995 and January 2001, 668 consecutive patients underwent brachytherapy using either (103)Pd or (125)I for clinical Stage T1b-T3aNxM0 (2002 American Joint Committee on Cancer) adenocarcinoma of the prostate gland. No patient underwent seminal vesicle biopsy or pathologic lymph node staging. The median follow-up was 58.6 months. Biochemical progression-free survival was defined by the American Society for Therapeutic Radiology and Oncology consensus definition. The clinical, treatment, and dosimetric parameters evaluated for biochemical progression-free survival included supplemental EBRT, ADT, patient age, clinical stage, Gleason score, preimplant prostate specific antigen (PSA), risk group, percentage of positive biopsies, isotope used, prostate volume, planning volume, percentage of target volume receiving 100%, 150%, and 200% of prescribed dose, minimal percentage of dose covering 90% of target volume, tobacco status, hypertension, and diabetes.
For the entire group, the actuarial 8-year biochemical progression-free survival rate was 98.2%, 98.4%, and 88.2% for low-, intermediate-, and high-risk patients, respectively, with a median PSA level of <0.1 ng/mL for all risk groups and ADT and EBRT subgroups. At last follow-up, only 5 patients (0.8%) had died of metastatic prostate cancer. In multivariate analysis, Gleason score, percentage of positive biopsies, and ADT predicted for biochemical outcome in high-risk patients. In low- and intermediate-risk patients, none of the evaluated variables predicted for biochemical outcome. For the entire population, pretreatment PSA level, Gleason score, ADT, and clinical stage predicted for 8-year biochemical progression-free survival, with the percentage of positive biopsies approaching statistical significance.
Prostate brachytherapy results in a high probability of 8-year biochemical progression-free survival for low-, intermediate-, and high-risk patients. Although the role of supplemental EBRT could not be adequately evaluated in high-risk patients, it did not improve biochemical outcome in low- and intermediate-risk patients. However, ADT resulted in a statistically significant improvement in progression-free survival for high-risk patients.
评估辅助外照射放疗（EBRT）和/或雄激素剥夺疗法（ADT）对永久性前列腺近距离放射治疗后8年生化结局的影响。
1995年4月至2001年1月期间，668例连续患者接受了使用¹⁰³Pd或¹²⁵I的近距离放射治疗，用于临床分期为T1b-T3aNxM0（2002年美国癌症联合委员会）的前列腺腺癌。没有患者接受精囊活检或病理淋巴结分期。中位随访时间为58.6个月。生化无进展生存期由美国放射肿瘤学会的共识定义确定。评估生化无进展生存期的临床、治疗和剂量学参数包括辅助EBRT、ADT、患者年龄、临床分期、Gleason评分、植入前前列腺特异性抗原（PSA）、风险组、阳性活检百分比、使用的同位素、前列腺体积、计划体积、接受100%、150%和200%处方剂量的靶体积百分比、覆盖90%靶体积的最小剂量百分比、吸烟状况、高血压和糖尿病。
对于整个队列，低、中、高风险患者的8年精算生化无进展生存率分别为98.2%、98.4%和88.2%，所有风险组以及ADT和EBRT亚组的中位PSA水平均<0.1 ng/mL。在最后一次随访时，只有5例患者（0.8%）死于转移性前列腺癌。在多变量分析中，Gleason评分、阳性活检百分比和ADT可预测高风险患者的生化结局。在低风险和中等风险患者中，没有评估变量可预测生化结局。对于整个人群，治疗前PSA水平、Gleason评分、ADT和临床分期可预测8年生化无进展生存期，阳性活检百分比接近统计学意义。
前列腺近距离放射治疗使低、中、高风险患者有很高的概率实现8年生化无进展生存。虽然辅助EBRT在高风险患者中的作用无法得到充分评估，但它并未改善低风险和中等风险患者的生化结局。然而，ADT使高风险患者的无进展生存期有统计学意义的改善。
