Dattoli Michael, Wallner Kent, True Lawrence, Cash Jennifer, Sorace Richard
Dattoli Cancer Center & Brachytherapy Research Institute, Sarasota, Florida, USA.
Cancer. 2007 Aug 1;110(3):551-5. doi: 10.1002/cncr.22810.
This study summarizes long-term outcomes from treatment of prostate cancer with increased risk of extracapsular cancer extension (ECE) using brachytherapy-based treatment.
A total of 282 consecutive patients were treated from 1992-1996 by 1 author (M.D.). Two hundred forty-three patients had at least 1 higher risk feature for ECE including Gleason Score 7-10 (172), prostate-specific antigen (PSA) above 10 (166), and clinical stages T(2c) (109) and T(3) (107). Using National Comprehensive Cancer Network (NCCN) guidelines, 119 patients had intermediate-risk disease and 124 had high-risk disease. Patients received pelvic 3-dimensional conformal external beam radiation followed by a palladium (Pd)-103 boost. Generous brachytherapy margins were utilized. Biochemical failure was defined using ASTRO Consensus Definition, nadir +2 and PSA >0.2 ng/mL at last follow-up. The nonfailing patient follow-up period was 1-14 years (median, 9.5 years). Biochemical data and original biopsy slides were independently re-reviewed at the University of Washington (by K.W. and L.T., respectively).
Overall actuarial freedom from biochemical progression at 14 years was 81%, including 87% and 72% having intermediate and high-risk disease, respectively. Absolute risk of failure decreased progressively, falling to 1% beyond 6 years after treatment. All failing patients had prostate biopsies without evidence of local recurrence. The strongest predictor of failure was Gleason score (P = .03) followed by PSA (P = .041). Treatment morbidity was limited to temporary RTOG grade 1-2 urinary and gastrointestinal symptoms.
High tumor control rates are possible with beam radiation followed by Pd-103 brachytherapy. Despite perceptions that brachytherapy is inappropriate for patients at higher risk for ECE, this series strengthens the rationale that brachytherapy-based treatment may be a desirable modality for such patients.
本研究总结了采用以近距离放射治疗为基础的方法治疗具有较高包膜外癌扩展（ECE）风险的前列腺癌的长期疗效。
1992年至1996年期间，由1名作者（医学博士）连续治疗了282例患者。243例患者至少具有1项ECE的高风险特征，包括 Gleason评分7 - 10分（172例）、前列腺特异性抗原（PSA）高于10（166例）以及临床分期T(2c)（109例）和T(3)（107例）。根据美国国立综合癌症网络（NCCN）指南，119例患者患有中风险疾病，124例患有高风险疾病。患者接受盆腔三维适形外照射，随后进行钯（Pd）- 103增敏治疗。采用了较大的近距离放射治疗边界。生化失败采用美国放射肿瘤学会（ASTRO）共识定义，即最低点加2且最后一次随访时PSA > 0.2 ng/mL来定义。未发生失败的患者随访期为1至14年（中位数为9.5年）。华盛顿大学（分别由K.W.和L.T.）对生化数据和原始活检玻片进行了独立复查。
14年时总体生化无进展精算自由度为81%，其中患有中风险疾病和高风险疾病的患者分别为87%和72%。失败的绝对风险逐渐降低，治疗后6年以上降至1%。所有失败患者的前列腺活检均未发现局部复发证据。失败的最强预测因素是Gleason评分（P = 0.03），其次是PSA（P = 0.041）。治疗相关并发症仅限于暂时性的放射肿瘤学（RTOG）1 - 2级泌尿和胃肠道症状。
外照射后进行Pd - 103近距离放射治疗可实现较高的肿瘤控制率。尽管有人认为近距离放射治疗不适用于ECE风险较高的患者，但本系列研究强化了基于近距离放射治疗的方法可能是这类患者理想治疗方式的理论依据。
