Izard Michael A, Haddad Richard L, Fogarty Gerald B, Rinks Adrian, Dobbins Timothy, Katelaris Philip
Radiation Oncology Associates, Mater Hospital, North Sydney, NSW, Australia.
Int J Radiat Oncol Biol Phys. 2006 Sep 1;66(1):38-47. doi: 10.1016/j.ijrobp.2006.04.002.
To present preliminary outcomes of pulsed dose rate brachytherapy (PDR-BT), external beam radiotherapy (EBRT), and hormonal manipulation, for prostate cancer.
Between December 1999 and January 2005, 165 consecutive patients with Stage T1-T3, N0, M0 prostate cancer were treated. Hormones were used in every patient. Median follow-up was 36 months. Risk groups were low (either Stage < or =T2a, +/- Gleason score < or =6, +/- Prostate-Specific Antigen [PSA] level < or =10 ng/mL); intermediate (either Stage T2b,c, +/- Gleason score 7, +/- PSA 10-20 ng/mL); and high (either Stage T3, +/- Gleason score 8-10, +/- PSA >20 ng/mL).
At 3 years, Radiotherapy Oncology Group (RTOG) Grade 3 and 4 genito-urinary toxicity was 4% and 1.4%; RTOG Grade 3 and 4 gastro-intestinal toxicity was 2.6% and 0%, respectively. Erectile preservation was 61%. Overall survival was 93% (154 of 165) and cause-specific survival was 98% (162 of 165). At 3 years, disease free survival (DFS) was 93% (153 of 165). DFS for low-, intermediate-, and high-risk groups was 100%, 97%, and 81%, respectively (chi(2) (2) = 16.02, p = 0.0003). The nadir plus 2 ng/mL definition (chi(2) (2) = 14.49, p = 0.0007) best predicted clinical failure, having the lowest false-positive rate (3 of 165). The nadir plus 2 ng/mL PSA-progression-free survival (PSA-PFS) rate was 100%, 95%, and 87% for the low-, intermediate, and high-risk groups, respectively. Overall ASTRO PSA-PFS rate was 88%.
Pulsed dose rate brachytherapy plus EBRT is effective in treating localized prostate cancer, with acceptable toxicity. However, a median 5-year PSA-PFS follow-up is required before providing a solid recommendation. This preliminary information supports continued use.
介绍前列腺癌的脉冲剂量率近距离放射治疗（PDR-BT）、外照射放疗（EBRT）及激素治疗的初步结果。
1999年12月至2005年1月，连续治疗165例T1-T3期、N0、M0前列腺癌患者。所有患者均使用了激素。中位随访时间为36个月。风险分组为低危（T2a期及以下，Gleason评分≤6分，前列腺特异性抗原[PSA]水平≤10 ng/mL）；中危（T2b、c期，Gleason评分7分，PSA 10-20 ng/mL）；高危（T3期，Gleason评分8-10分，PSA＞20 ng/mL）。
3年时，放射肿瘤学组（RTOG）3级和4级泌尿生殖系统毒性分别为4%和1.4%；RTOG 3级和4级胃肠道毒性分别为2.6%和0%。勃起功能保留率为61%。总生存率为93%（165例中的154例），病因特异性生存率为98%（165例中的162例）。3年时，无病生存率（DFS）为93%（165例中的153例）。低危、中危和高危组的DFS分别为100%、97%和81%（χ²(2)=16.02，p=0.0003）。最低点加2 ng/mL的定义（χ²(2)=14.49，p=0.0007）对临床失败的预测最佳，假阳性率最低（165例中的3例）。低危、中危和高危组的最低点加2 ng/mL PSA无进展生存率（PSA-PFS）分别为100%、95%和87%。总体ASTRO PSA-PFS率为88%。
脉冲剂量率近距离放射治疗联合EBRT治疗局限性前列腺癌有效，毒性可接受。然而，在给出可靠推荐之前，需要进行中位5年的PSA-PFS随访。这些初步信息支持继续使用。
