Khaksar Sara Jane, Laing Robert W, Henderson Alastair, Sooriakumaran Prasanna, Lovell David, Langley Stephen E M
Deptartment of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
BJU Int. 2006 Dec;98(6):1210-5. doi: 10.1111/j.1464-410X.2006.06520.x. Epub 2006 Oct 11.
To report our clinical experience and 5-year prostate-specific antigen (PSA) relapse-free survival rate for early-stage prostate cancer after (125)I low-dose-rate prostate brachytherapy.
In all, 300 patients were treated between March 1999 and April 2003, and followed prospectively. Patients were stratified into low-, intermediate- and high-risk groups, and those receiving neoadjuvant androgen deprivation (NAAD) or not. Kaplan-Meier estimates of PSA relapse-free survival and PSA nadirs were obtained for all patients and for the risk groups. Toxicity, as urinary and erectile dysfunction (ED), were reported from a prospective database.
The median (range) follow-up was 45 (33-82) months. The actuarial PSA relapse-free survival was 93% at 5 years; 21 (7%) of patients had evidence of biochemical failure as defined by the American Society of Therapeutic Radiation Oncology criteria. There was no significant difference in actuarial survival for patients in the different risk groups, or between those receiving NAAD or not (low-risk 96%, intermediate 89%, high 93%, P = 0.12; NAAD 92%, no NAAD 95%, P = 0.30). Overall the 3-year median PSA level was 0.3 ng/mL (192 men). There was no significant difference in median 3-year PSA levels for different risk groups, or for those treated with or with no NAAD. The 3- and 4-year PSA nadir of <0.5 ng/mL was achieved by 71% and 86% of men, respectively. The acute urinary retention rate was 7%; 5.6% of men developed urethral strictures requiring dilatation, while 2.7% required a transurethral resection of the prostate after implantation, for obstructive symptoms. Of patients with no ED before treatment, 62% had no ED at 2 years, and of these 60% used a phosphodiesterase inhibitor.
This prospective series confirms the excellent overall biochemical survival after (125)I brachytherapy; the treatment was tolerated well, with early and late urinary toxicity and ED similar to other published results.
报告我们关于¹²⁵I低剂量率前列腺近距离放射治疗早期前列腺癌的临床经验及5年无前列腺特异性抗原（PSA）复发生存率。
1999年3月至2003年4月期间共治疗300例患者，并进行前瞻性随访。患者被分为低危、中危和高危组，且分为接受或未接受新辅助雄激素剥夺（NAAD）治疗的患者。对所有患者及各风险组进行PSA无复发生存率和PSA最低点的Kaplan-Meier估计。从一个前瞻性数据库中报告毒性情况，如排尿和勃起功能障碍（ED）。
中位（范围）随访时间为45（33 - 82）个月。5年精算PSA无复发生存率为93%；21例（7%）患者有美国放射肿瘤学会标准定义的生化失败证据。不同风险组患者的精算生存率，以及接受或未接受NAAD治疗的患者之间无显著差异（低危组96%，中危组89%，高危组93%，P = 0.12；接受NAAD治疗组92%，未接受NAAD治疗组95%，P = 0.30）。总体而言，3年中位PSA水平为0.3 ng/mL（192例男性）。不同风险组或接受与未接受NAAD治疗的患者，其3年中位PSA水平无显著差异。分别有71%和86%的男性在3年和4年时PSA最低点<0.5 ng/mL。急性尿潴留率为7%；5.6%的男性出现需要扩张的尿道狭窄，而2.7%的男性在植入后因梗阻症状需要行经尿道前列腺切除术。在治疗前无ED的患者中，62%在2年时无ED，其中60%使用磷酸二酯酶抑制剂。
这个前瞻性系列研究证实了¹²⁵I近距离放射治疗后总体生化生存情况良好；该治疗耐受性良好，早期和晚期排尿毒性及ED与其他已发表结果相似。
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