Merrick Gregory S, Butler Wayne M, Wallner Kent E, Galbreath Robert W, Adamovich Edward
Schiffler Cancer Center, Wheeling Hospital, USA.
W V Med J. 2005 Jul-Aug;101(4):168-71.
Since the mid-1980s, permanent prostate brachytherapy has been utilized increasingly as a potentially curative treatment for patients of all ages with clinically localized prostate cancer To determine the 8-year biochemical progression-free survival rate for patients who had undergone monotherapeutic brachytherapy for clinically organ-confined prostate cancer, we conducted a study of 202 patients at Schiffler Cancer Center at Wheeling Hospital in Wheeling, W.Va. These patients had undergone brachytherapy without supplemental external beam radiation therapy or androgen deprivation therapy for clinical T1b-T2c NxM0 (2002 AJCC) prostate cancer from April 1995 through May 2001. No patient underwent seminal vesicle biopsy or pathologic lymph node staging. The median follow-up was 5.2 years. All patients underwent brachytherapy more than 3 years prior to analysis. Biochemical success was defined as a PSA < 0.4 ng/mL after a nadir. Clinical, treatment and dosimetric parameters evaluated for biochemical progression-free survival included patient age, clinical T-stage, Gleason score, pretreatment PSA, risk group, percent positive biopsies, isotope, prostate volume, brachytherapy planning volume, V100/150/200, D90, tobacco status, hypertension and diabetes. For the entire group, 8-year biochemical progression-free survival was 97.4% for Pd-103 and 93.3% for I-125. The median post-treatment PSA for the entire group was < 0.1 ng/mL. In multivariate analysis, only pretreatment PSA predicted biochemical outcome with a trend for better outcome with younger patient age and lesser percent positive biopsies. The results of our study indicate that permanent interstitial brachytherapy as a monotherapeutic approach for patients with clinically organ-confined disease results in a high probability of 8-year biochemical progression-free survival with a median PSA < 0.1 ng/mL. Generous periprostatic treatment margins with documented high quality day 0 postoperative dosimetry are mandatory for such outcomes.
自20世纪80年代中期以来，永久性前列腺近距离放射治疗越来越多地被用作所有年龄段临床局限性前列腺癌患者的一种潜在治愈性治疗方法。为了确定临床器官局限性前列腺癌接受单一近距离放射治疗患者的8年无生化进展生存率，我们在西弗吉尼亚州惠灵市惠灵医院的希夫勒癌症中心对202例患者进行了一项研究。这些患者在1995年4月至2001年5月期间，因临床T1b-T2c NxM0（2002 AJCC）前列腺癌接受了近距离放射治疗，未接受辅助外照射放疗或雄激素剥夺治疗。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5.2年。所有患者在分析前3年多接受了近距离放射治疗。生化成功定义为最低点后PSA＜0.4 ng/mL。评估无生化进展生存率的临床、治疗和剂量学参数包括患者年龄、临床T分期、Gleason评分、治疗前PSA、风险组、活检阳性百分比、同位素、前列腺体积、近距离放射治疗计划体积、V100/150/200、D90、吸烟状况、高血压和糖尿病。对于整个组，Pd-103的8年无生化进展生存率为97.4%，I-125为93.3%。整个组治疗后的中位PSA＜0.1 ng/mL。在多变量分析中，只有治疗前PSA可预测生化结果，年轻患者年龄和较低的活检阳性百分比有更好结果的趋势。我们的研究结果表明，永久性组织间近距离放射治疗作为临床器官局限性疾病患者的单一治疗方法，可使8年无生化进展生存率很高，中位PSA＜0.1 ng/mL。为了取得这样的结果，必须有记录的高质量术后第0天前列腺周围治疗边界。
