Stübinger S H, Wilhelm R, Kaufmann S, Döring M, Hautmann S, Jünemann K P, Galalae R
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Urologe A. 2008 Mar;47(3):284-90. doi: 10.1007/s00120-008-1634-4.
Prostate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20-30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80-90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours. The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.
前列腺癌（PCA）是男性中最常见的肿瘤疾病。欧洲每年约有20.2万例前列腺癌新发病例。通过近距离放射治疗对这种癌症进行根治性治疗正变得越来越重要（占所有根治性治疗方法的20%-30%）。在治疗开始前进行初始分期并因此将患者分配到风险组对于成功的近距离放射治疗尤为重要。低剂量率（LDR）近距离放射治疗（即种子植入）在操作过程以及适应症方面与高剂量率近距离放射治疗（后装治疗）有所不同。这两种治疗方法都可作为单一疗法使用，也可与外照射联合使用。据报道，LDR单一疗法在10年随访期内可使低风险肿瘤的生化无复发生存率高达90%。据报道，高剂量率远距离和近距离联合放射治疗在长期随访中可使中、高风险肿瘤的生化无复发生存率达到80%-90%。虽然目前还缺乏随机研究，但仍可从监测研究和队列研究中得出以下应用算法：LDR单一近距离放射治疗的应用必须限于低风险肿瘤。高剂量率远距离和近距离联合放射治疗可成功应用于中、高风险肿瘤病例。治疗结果很大程度上取决于初始的治疗前前列腺特异抗原（PSA）值和 Gleason评分。治疗后，最低点值对于预测生化无复发生存率至关重要。
