Merrick Gregory S, Wallner Kent E, Butler Wayne M, Blasko John C
Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia 26003-6300, USA.
Oncology (Williston Park). 2006 Apr;20(5):514-22; discussion 522-5.
Permanent prostate brachytherapy with or without supplemental therapies is a highly effective treatment for clinically localized prostate cancer, with biochemical outcomes and morbidity profiles comparing favorably with competing local modalities. However, the absence of prospective randomized brachytherapy trials evaluating the role of supplemental external-beam radiation therapy (XRT) has precluded the development of evidence-based treatment algorithms for the appropriate inclusion of such treatment. Some groups advocate supplemental XRT for all patients, but the usefulness of this technology remains largely unproven and has been questioned by recent reports of favorable biochemical outcomes following brachytherapy used alone in patients at higher risk. Given that brachytherapy can be used at high intraprostatic doses and can obtain generous periprostatic treatment margins, the use of supplemental XRT may be relegated to patients with a high risk of seminal vesicle and/or pelvic lymph node involvement. Although morbidity following brachytherapy has been acceptable, supplemental XRT has shown an adverse impact on long-term quality of life. The completion of ongoing prospective randomized trials will help define the role of XRT as a supplement to permanent prostate brachytherapy.
永久性前列腺近距离放射治疗无论是否联合辅助治疗，都是临床局限性前列腺癌的一种高效治疗方法，其生化指标结果和发病率情况与其他局部治疗方式相比具有优势。然而，由于缺乏评估辅助外照射放疗（XRT）作用的前瞻性随机近距离放射治疗试验，因此无法制定基于证据的治疗算法来合理纳入此类治疗。一些团体主张对所有患者进行辅助XRT，但这项技术的有效性在很大程度上仍未得到证实，并且近期关于高风险患者单独使用近距离放射治疗后生化指标结果良好的报告也对此提出了质疑。鉴于近距离放射治疗可在高前列腺内剂量下使用，并能获得足够的前列腺周围治疗边界，辅助XRT的使用可能仅限于精囊和/或盆腔淋巴结受累风险较高的患者。尽管近距离放射治疗后的发病率是可以接受的，但辅助XRT已显示出对长期生活质量有不利影响。正在进行的前瞻性随机试验的完成将有助于确定XRT作为永久性前列腺近距离放射治疗辅助手段的作用。
