Department of Radiation Oncology, University of California San Francisco, School of Medicine, San Francisco, CA, USA.
Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):36-42. doi: 10.1016/j.ijrobp.2009.01.029.
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.
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.
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).
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.
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。
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。
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%）。
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。
