Demanes D Jeffrey, Brandt David, Schour Lionel, Hill Dennis R
California Endocurietherapy Cancer Center, 3012 Summit Street Suite 2675, Oakland, CA 94610, USA.
Am J Clin Oncol. 2009 Aug;32(4):342-7. doi: 10.1097/COC.0b013e31818cd277.
Prostate cancer patients treated with high dose rate brachytherapy and external beam radiation therapy were stratified by risk group for analysis to determine whether androgen deprivation therapy (ADT) affected outcome.
From 1991 through 1998, 411 patients were treated with 4 fractions of 5.5 to 6.0 Gy high dose rate brachytherapy and a total of 36.0 to 39.6 Gy external beam radiation therapy (dose escalation over time). The dataset was prospective. Administration of ADT was not randomized, but it was the primary study variable. During this period, ADT was administered across all risk groups for various indications. It did not necessarily reflect advanced disease or large prostate size. There were 200 patients in the "ADT Group" (20% low, 48% intermediate, and 32% high risk) and 211 in the "No ADT Group" (33% low, 44% intermediate, 23% high risk). The median follow-up was 6.4 years. Cases were grouped according to low, intermediate, and high risk groups to reduce the effects of unrecognized selection bias for or against the ADT group. The prostate specific antigen (PSA) nadir plus 2.0 ng/ml (nadir + 2) was used as the biochemical control end point. Local control, PSA progression-free survival, distant metastasis free survival, and cause-specific survival were compared.
The 10 year PSA-PFS (nadir + 2) for all 411 patients was 81%. The results stratified by risk group were: low 92%, intermediate 87%, and high 63%. The low and intermediate risk groups were not statistically different from one another but they were both significantly better than the high risk group. ADT versus No ADT 10-year survival showed no significant differences for any outcome variable: PSA-PFS (83% vs. 81% ns), local control (97% vs. 99%), distant metastasis free survival (94% vs. 97%), and cause-specific survival (97% vs. 97%). A subset analysis of PSA-PFS (nadir + 2) stratified by risk group revealed no difference between the ADT and No ADT groups.
high dose rate brachytherapy and external beam radiation therapy resulted in high rates of local control, PSA progression-free survival, distant metastasis free survival, and cause-specific survival in all risk groups. Improved outcome from the use of androgen deprivation was not observed.
对接受高剂量率近距离放射治疗和外照射放疗的前列腺癌患者按风险组进行分层分析，以确定雄激素剥夺治疗（ADT）是否会影响治疗结果。
1991年至1998年期间，411例患者接受了4次剂量为5.5至6.0 Gy的高剂量率近距离放射治疗以及总量为36.0至39.6 Gy的外照射放疗（剂量随时间递增）。该数据集为前瞻性研究。ADT的使用并非随机分配，但它是主要的研究变量。在此期间，所有风险组的患者因各种适应证接受了ADT治疗。这不一定反映疾病进展或前列腺体积较大。“ADT组”有200例患者（低风险20%，中风险48%，高风险32%），“非ADT组”有211例患者（低风险33%，中风险44%，高风险23%）。中位随访时间为6.4年。病例根据低、中、高风险组进行分组，以减少对ADT组存在或不存在的未识别选择偏倚的影响。前列腺特异性抗原（PSA）最低点加上2.0 ng/ml（最低点 + 2）被用作生化控制终点。比较局部控制、无PSA进展生存期、无远处转移生存期和特定病因生存期。
411例患者的10年无PSA进展生存期（最低点 + 2）为81%。按风险组分层的结果为：低风险组92%，中风险组87%，高风险组63%。低风险组和中风险组之间无统计学差异，但二者均显著优于高风险组。ADT组与非ADT组的10年生存率在任何结局变量上均无显著差异：无PSA进展生存期（83%对81%，无显著性差异）、局部控制（97%对99%）、无远处转移生存期（94%对97%）和特定病因生存期（97%对97%）。按风险组分层的PSA无进展生存期（最低点 + 2）的亚组分析显示，ADT组和非ADT组之间无差异。
高剂量率近距离放射治疗和外照射放疗在所有风险组中均导致了较高的局部控制率、无PSA进展生存期、无远处转移生存期和特定病因生存期。未观察到使用雄激素剥夺治疗能改善治疗结果。
