Phan Thinh P, Syed A M Nisar, Puthawala Ajmel, Sharma Anil, Khan Farhan
Department of Radiation Oncology, University of California-Irvine, Long Beach, California 90806, USA.
J Urol. 2007 Jan;177(1):123-7; discussion 127. doi: 10.1016/j.juro.2006.08.109.
We report the outcome and toxicities of high dose rate brachytherapy as a boost for localized prostate cancer.
Between 1996 and 2003, 309 patients with prostate carcinoma were treated with external beam radiation therapy and high dose rate brachytherapy. Furthermore, 36% of the patients received neoadjuvant/concurrent or adjuvant androgen deprivation therapy. Patients were stratified into 3 groups. Group 1 of 67 patients had Gleason score 6 or less, pretreatment prostate specific antigen 10 ng/ml or less and clinical stage T2a or less. Group 2 of 109 patients had Gleason score 7 or greater, pretreatment prostate specific antigen greater than 10 ng/ml and clinical stage T2b or greater. Group 3 of 133 patients had 2 or more of these higher risk factors.
At a median followup of 59 months the 5-year biochemical control rate, as defined by the American Society for Therapeutic Radiation and Oncology, was 86%, cause specific survival was 98% and overall survival was 91%. Biochemical control in stratified groups 1 to 3 was 98%, 90% and 78%, respectively. On univariate analysis risk group, pretreatment prostate specific antigen and Gleason score were significant predictors of biochemical control. However, on multivariate analysis only risk group and pretreatment prostate specific antigen were significant. Using the Common Toxicity Criteria scale there were 2 cases of grade 3 acute urinary toxicity. Regarding late side effects 4% of patients had grade 3 genitourinary toxicity and 1 had a grade 4 rectal complication.
External beam radiation therapy and high dose rate brachytherapy for prostate cancer resulted in excellent biochemical control, cause specific survival and overall survival with minimal severe acute or late complications.
我们报告高剂量率近距离放射治疗作为局限性前列腺癌辅助治疗的疗效及毒性反应。
1996年至2003年间，309例前列腺癌患者接受了外照射放疗及高剂量率近距离放射治疗。此外，36%的患者接受了新辅助/同步或辅助雄激素剥夺治疗。患者被分为3组。第1组67例患者，Gleason评分6分及以下，治疗前前列腺特异性抗原10 ng/ml及以下，临床分期T2a及以下。第2组109例患者，Gleason评分7分及以上，治疗前前列腺特异性抗原大于10 ng/ml，临床分期T2b及以上。第3组133例患者有2种或更多上述高危因素。
中位随访59个月时，按照美国放射肿瘤学会的定义，5年生化控制率为86%，病因特异性生存率为98%，总生存率为91%。分层后的第1至3组生化控制率分别为98%、90%和78%。单因素分析显示，风险组、治疗前前列腺特异性抗原和Gleason评分是生化控制的显著预测因素。然而，多因素分析显示只有风险组和治疗前前列腺特异性抗原具有显著性。按照常见毒性标准量表，有2例3级急性泌尿系统毒性反应。关于晚期副作用，4%的患者有3级泌尿生殖系统毒性反应，1例有4级直肠并发症。
前列腺癌的外照射放疗及高剂量率近距离放射治疗可实现良好的生化控制、病因特异性生存及总生存，且严重急性或晚期并发症极少。
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