Zwahlen Daniel R, Andrianopoulos Nick, Matheson Bronwyn, Duchesne Gillian M, Millar Jeremy L
Department of Radiation Oncology, The William Buckland Radiotherapy Centre, Alfred Hospital, Melbourne, Victoria, Australia.
Brachytherapy. 2010 Jan-Mar;9(1):27-35. doi: 10.1016/j.brachy.2009.04.007. Epub 2009 Oct 20.
To report long-term outcomes for treatment of prostate cancer using dose escalation with high-dose-rate (HDR) brachytherapy and 3-dimensional conformal external beam radiotherapy (3DCRT), and compare them with outcomes for treatment of prostate cancer with 3DCRT alone at the same institution.
From 1998 to 2003, 587 patients were treated for clinically localized prostate cancer. Patients received either 3DCRT (median, 46Gy) with a single HDR brachytherapy implant (196 patients) delivering a fractionated dose of 18Gy (combined group) or 3DCRT (median, 70Gy; 387 patients; "3DCRT alone"). There were 41.9% patients with intermediate-risk and 42.6% with high-risk disease. In all, 441 patients (75.1%) received neoadjuvant and 116 patients (19.8%) received adjuvant androgen deprivation therapy. The American Society of Therapeutic Radiology and Oncology Phoenix definition for biochemical failure was used.
The median followup was 5.5 years. The 5- and 7-year biochemical control (BC) rates were 82.5% and 80.3%, respectively, for the combined group and 81.3% and 71%, respectively, for 3DCRT alone; for overall survival, they were 91.9% and 89.5% vs. 88.7% and 86.2%, respectively, whereas for cause-specific survival, they were 96.9% and 96.1% vs. 97.6% and 96.2%, respectively. Cox proportional hazard regression analysis for BC revealed that low Gleason grade, HDR brachytherapy combined with 3DCRT, and adjuvant androgen deprivation therapy were significant in predicting BC. Radiation Therapy Oncology Group Grade 3 late urinary and rectal morbidity rates were 7.1% and 0%, respectively. No Grade > or =4 reactions were detected.
HDR brachytherapy combined with 3DCRT was associated with improved BC and minimal toxicity in patients with unfavorable prostate cancer compared with conventional 3DCRT.
报告采用高剂量率（HDR）近距离放射治疗联合三维适形外照射放疗（3DCRT）进行剂量递增治疗前列腺癌的长期结果，并将其与同一机构单纯使用3DCRT治疗前列腺癌的结果进行比较。
1998年至2003年，587例临床局限性前列腺癌患者接受了治疗。患者接受了3DCRT（中位剂量46Gy）联合单次HDR近距离放射治疗植入（196例患者），分次剂量为18Gy（联合组）或3DCRT（中位剂量70Gy；387例患者；“单纯3DCRT组”）。有41.9%的患者为中危疾病，42.6%为高危疾病。总共441例患者（75.1%）接受了新辅助治疗，116例患者（19.8%）接受了辅助雄激素剥夺治疗。采用美国放射肿瘤学会凤凰城生化失败定义。
中位随访时间为5.5年。联合组5年和7年的生化控制（BC）率分别为82.5%和80.3%，单纯3DCRT组分别为81.3%和71%；总生存率方面，联合组分别为91.9%和89.5%，单纯3DCRT组分别为88.7%和86.2%；而病因特异性生存率方面，联合组分别为96.9%和96.1%，单纯3DCRT组分别为97.6%和96.2%。BC的Cox比例风险回归分析显示，低Gleason分级、HDR近距离放射治疗联合3DCRT以及辅助雄激素剥夺治疗在预测BC方面具有显著性。放射肿瘤学组3级晚期泌尿和直肠发病率分别为7.1%和0%。未检测到≥4级反应。
与传统3DCRT相比，HDR近距离放射治疗联合3DCRT在预后不良的前列腺癌患者中与改善的BC和最小的毒性相关。
