Dattoli Michael, Wallner Kent, True Lawrence, Cash Jennifer, Sorace Richard
Dattoli Cancer Center and Brachytherapy Research Institute, Sarasota, Florida 34217, USA.
Urology. 2007 Feb;69(2):334-7. doi: 10.1016/j.urology.2006.09.045.
To report the long-term biochemical control rates with brachytherapy-based treatment for patients with prostate cancer at high risk of extracapsular cancer extension.
A total of 243 consecutive patients with at least one higher risk factor (Gleason score of 7 or worse, prostate-specific antigen [PSA] level greater than 10 ng/mL, or elevated prostatic acid phosphatase level greater than 2.5 U) who were treated with palladium-103 plus supplemental external beam radiotherapy from 1992 through 1996 were included in this study. Patients received 41 Gy external beam radiotherapy to a limited pelvic field, followed 4 weeks later by a palladium-103 boost. The prescribed minimal palladium-103 dose to the prostate was 80 to 90 Gy. Freedom from biochemical failure was defined as a serum PSA level of 0.2 ng/mL or less at the last follow-up visit.
Of the 243 patients, 41 developed biochemical failure. The overall actuarial freedom from biochemical progression rate at 13 years was 81%, with 198 patients followed up for longer than 5 years. The overall actuarial freedom from failure rate for the 93 patients with a PSA level of 10 ng/mL or greater and Gleason score of 7 or greater was 74% at 5 years and 72% at 10 years. The overall actuarial freedom from failure rate for the 66 patients with elevated prostatic acid phosphatase was 65% at 10 years. The absolute risk of failure decreased progressively with time, falling to 1% by 6 years after treatment. On Cox proportional hazard multivariate analysis, considering each factor as a continuous variable, the strongest predictor of failure was the acid phosphatase level (P <0.0001), followed by Gleason score (P = 0.42) and PSA level (P = 0.15).
The evidence from this patient group at high risk of extracapsular cancer extension suggests that the relatively high tumor control rates with brachytherapy-based therapy are durable.
报告对有前列腺癌包膜外侵犯高风险患者采用近距离放射治疗的长期生化控制率。
本研究纳入了1992年至1996年期间连续接受钯-103联合补充外照射放疗的243例患者，这些患者至少有一项高风险因素（ Gleason评分7分或更高、前列腺特异性抗原[PSA]水平大于10 ng/mL或前列腺酸性磷酸酶水平高于2.5 U）。患者先接受41 Gy外照射至有限盆腔野，4周后进行钯-103增敏照射。规定的前列腺钯-103最小剂量为80至90 Gy。生化无失败定义为末次随访时血清PSA水平为0.2 ng/mL或更低。
243例患者中，41例出现生化失败。13年时总体生化进展无进展率为81%，198例患者随访时间超过5年。93例PSA水平为10 ng/mL或更高且Gleason评分7分或更高患者的5年总体无失败率为74%，10年时为72%。66例前列腺酸性磷酸酶升高患者的10年总体无失败率为65%。失败的绝对风险随时间逐渐降低，治疗后6年降至1%。在Cox比例风险多因素分析中，将每个因素视为连续变量，失败的最强预测因素是酸性磷酸酶水平（P<0.0001），其次是Gleason评分（P = 0.42）和PSA水平（P = 0.15）。
来自该有包膜外侵犯高风险患者组的证据表明，基于近距离放射治疗的相对较高肿瘤控制率是持久的。
