对接受永久性前列腺近距离放射治疗的Gleason评分7-10分前列腺癌患者，高生物有效剂量对生化失败和生存结局影响的多中心分析。
Multicenter analysis of effect of high biologic effective dose on biochemical failure and survival outcomes in patients with Gleason score 7-10 prostate cancer treated with permanent prostate brachytherapy.
作者信息
Stone Nelson N, Potters Louis, Davis Brian J, Ciezki Jay P, Zelefsky Michael J, Roach Mack, Shinohara Katsuto, Fearn Paul A, Kattan Michael W, Stock Richard G
机构信息
Mount Sinai School of Medicine, New York, NY, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):341-6. doi: 10.1016/j.ijrobp.2008.04.038. Epub 2008 Jul 1.
PURPOSE
To investigate the biochemical control rates and survival for Gleason score 7-10 prostate cancer patients undergoing permanent prostate brachytherapy as a function of the biologic effective dose (BED).
METHODS AND MATERIALS
Six centers provided data on 5,889 permanent prostate brachytherapy patients, of whom 1,078 had Gleason score 7 (n = 845) or Gleason score 8-10 (n = 233) prostate cancer and postimplant dosimetry results available. The median prostate-specific antigen level was 7.5 ng/mL (range, 0.4-300). The median follow-up for censored patients was 46 months (range, 5-130). Short-term hormonal therapy (median duration, 3.9 months) was used in 666 patients (61.8%) and supplemental external beam radiotherapy (EBRT) in 620 (57.5%). The patients were stratified into three BED groups: <200 Gy (n = 645), 200-220 Gy (n = 199), and >220 Gy (n = 234). Biochemical freedom from failure (bFFF) was determined using the Phoenix definition.
RESULTS
The 5-year bFFF rate was 80%. The bFFF rate stratified by the three BED groups was 76.4%, 83.5%, and 88.3% (p < 0.001), respectively. Cox regression analysis revealed Gleason score, prostate-specific antigen level, use of hormonal therapy, EBRT, and BED were associated with bFFF (p < 0.001). Freedom from metastasis improved from 92% to 99% with the greatest doses. The overall survival rate at 5 years for the three BED groups for Gleason score 8-10 cancer was 86.6%, 89.4%, and 94.6%, respectively (p = 0.048).
CONCLUSION
These data suggest that permanent prostate brachytherapy combined with EBRT and hormonal therapy yields excellent bFFF and survival results in Gleason score 7-10 patients when the delivered BEDs are >220 Gy. These doses can be achieved by a combination of 45-Gy EBRT with a minimal dose received by 90% of the target volume of 120 Gy of (103)Pd or 130 Gy of (125)I.
目的
研究接受永久性前列腺近距离放射治疗的Gleason评分7 - 10分前列腺癌患者的生化控制率和生存率与生物等效剂量（BED）之间的关系。
方法和材料
六个中心提供了5889例接受永久性前列腺近距离放射治疗患者的数据，其中1078例患者患有Gleason评分7分（n = 845）或Gleason评分8 - 10分（n = 233）的前列腺癌且有植入后剂量测定结果。前列腺特异性抗原水平的中位数为7.5 ng/mL（范围为0.4 - 300）。截尾患者的中位随访时间为46个月（范围为5 - 130个月）。666例患者（61.8%）使用了短期激素治疗（中位持续时间为3.9个月），620例患者（57.5%）接受了补充外照射放疗（EBRT）。患者被分为三个BED组：<200 Gy（n = 645）、200 - 220 Gy（n = 199）和>220 Gy（n = 234）。采用Phoenix定义确定生化无失败生存率（bFFF）。
结果
5年bFFF率为80%。按三个BED组分层的bFFF率分别为76.4%、83.5%和88.3%（p < 0.001）。Cox回归分析显示，Gleason评分、前列腺特异性抗原水平、激素治疗的使用、EBRT和BED与bFFF相关（p < 0.001）。转移无进展率随着剂量增加从92%提高到99%。Gleason评分8 - 10分癌症的三个BED组5年总生存率分别为86.6%、89.4%和94.6%（p = 0.048）。
结论
这些数据表明，当给予的BED > 220 Gy时，永久性前列腺近距离放射治疗联合EBRT和激素治疗在Gleason评分7 - 10分的患者中可产生优异的bFFF和生存结果。这些剂量可通过45 - Gy的EBRT与90%靶体积接受的最小剂量120 Gy的（103）Pd或130 Gy的（125）I联合实现。
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