永久性前列腺种子植入近距离放射治疗与高剂量三维适形放疗和高剂量适形质子束放疗增敏相比，具有等效的生化控制和改善的前列腺特异性抗原最低值。
Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost.
机构信息
Department of Radiation Oncology, University of California San Francisco, School of Medicine, San Francisco, CA, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):36-42. doi: 10.1016/j.ijrobp.2009.01.029.
PURPOSE
Permanent prostate implant brachytherapy (PPI), three-dimensional conformal radiotherapy (3D-CRT), and conformal proton beam radiotherapy (CPBRT) are used in the treatment of localized prostate cancer, although no head-to-head trials have compared these modalities. We studied the biochemical control (biochemical no evidence of disease [bNED]) and prostate-specific antigen (PSA) nadir achieved with contemporary PPI, and evaluated it against 3D-CRT and CPBRT.
PATIENTS AND METHODS
A total of 249 patients were treated with PPI at the University of California, San Francisco, and the outcomes were compared with those from a 3D-CRT cohort and the published results of a high-dose CPBRT boost (CPBRTB) trial. For each comparison, subsets of the PPI cohort were selected with patient and disease criteria similar to those of the reference group.
RESULTS
With a median follow-up of 5.3 years, the bNED rate at 5 and 7 years achieved with PPI was 92% and 86%, respectively, using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, and 93% using the PSA nadir plus 2 ng/mL definition. Using the ASTRO definition, a 5-year bNED rate of 78% was achieved for the 3D-CRT patients compared with 94% for a comparable PPI subset and 93% vs. 92%, respectively, using the PSA nadir plus 2 ng/mL definition. The median PSA nadir for patients treated with PPI and 3D-CRT was 0.10 and 0.40 ng/mL, respectively (p < .0001). For the CPBRT comparison, the 5-year bNED rate after a CPBRTB was 91% using the ASTRO definition vs. 93% for a similar group of PPI patients. A greater proportion of PPI patients achieved a lower PSA nadir compared with those achieved in the CPBRTB trial (PSA nadir < or =0.5 ng/mL, 91% vs. 59%, respectively).
CONCLUSION
We have demonstrated excellent outcomes in low- to intermediate-risk patients treated with PPI, suggesting at least equivalent 5-year bNED rates and a greater proportion of men achieving lower PSA nadirs compared with 3D-CRT or CPBRTB.
目的
前列腺植入近距离放疗（PPI）、三维适形放疗（3D-CRT）和适形质子束放疗（CPBRT）均用于局限性前列腺癌的治疗，尽管尚未有头对头的临床试验比较这些方法。我们研究了现代 PPI 治疗的生化控制（生化无疾病证据[bNED]）和前列腺特异性抗原（PSA）最低值，并将其与 3D-CRT 和 CPBRT 进行了比较。
方法
共有 249 名患者在加州大学旧金山分校接受了 PPI 治疗，其结果与 3D-CRT 队列的结果和高剂量 CPBRT 推量（CPBRTB）试验的已发表结果进行了比较。对于每项比较，根据患者和疾病标准选择了 PPI 队列的子集，这些标准与参考组的标准相似。
结果
中位随访 5.3 年后，根据美国放射治疗肿瘤学会（ASTRO）的定义，PPI 组的 5 年和 7 年 bNED 率分别为 92%和 86%，PSA 最低值加 2ng/mL 定义的 bNED 率为 93%。根据 ASTRO 定义，3D-CRT 患者的 5 年 bNED 率为 78%，而可比 PPI 亚组的 bNED 率为 94%，PSA 最低值加 2ng/mL 定义的 bNED 率分别为 93%和 92%。接受 PPI 和 3D-CRT 治疗的患者的中位 PSA 最低值分别为 0.10 和 0.40ng/mL（p<0.0001）。对于 CPBRT 比较，ASTRO 定义的 CPBRTB 后 5 年 bNED 率为 91%，而类似 PPI 患者组的 bNED 率为 93%。与 CPBRTB 试验相比，更多的 PPI 患者达到了更低的 PSA 最低值（PSA 最低值<或=0.5ng/mL，分别为 91%和 59%）。
结论
我们已经证明了低危到中危患者接受 PPI 治疗的良好结果，这表明至少在 5 年 bNED 率和更多男性达到更低 PSA 最低值方面与 3D-CRT 或 CPBRTB 相当。
Zotero 插件