Wilder Richard B, Barme Greg A, Gilbert Ronald F, Holevas Richard E, Kobashi Luis I, Reed Richard R, Solomon Ronald S, Walter Nancy L, Chittenden Lucy, Mesa Albert V, Agustin Jeffrey K, Lizarde Jessica, Macedo Jorge C, Ravera John, Tokita Kenneth M
Cancer Center of Irvine, Irvine, CA 92618, USA.
Brachytherapy. 2010 Oct-Dec;9(4):341-8. doi: 10.1016/j.brachy.2009.08.003. Epub 2009 Oct 22.
To analyze results with high-dose-rate (HDR) brachytherapy and intensity modulated radiation therapy (IMRT) vs. IMRT alone for prostate cancer.
Between October 2003 and August 2008, 284 patients with early stage prostate cancer underwent HDR brachytherapy to 2200cGy and IMRT to 5040cGy (n=240) or IMRT alone to 7920-8100cGy (n=44).
The median followup was 2.2 years. There was no significant difference in terms of the proportions of patients who had diabetes mellitus (p=0.07) or who received hormonal therapy (p=0.75) by radiotherapy technique. The 3-year biochemical disease-free survival rates in low-risk, intermediate-risk, and high-risk patients treated with HDR brachytherapy and IMRT are 100%, 98%, and 93%, respectively. The 3-year biochemical disease-free survival rates in low-risk, intermediate-risk, and high-risk patients treated with IMRT alone are 100%, 100%, and 67%, respectively. There was no significant difference in biochemical disease-free survival or toxicity between treatment groups. The similarity in outcomes between treatment groups remained unchanged when we examined only hormone-naive patients.
The HDR brachytherapy and IMRT yielded similar biochemical disease-free survival and toxicity to IMRT alone. As a result, we continue to base treatment on physician and patient preference. Longer followup will help to determine the role of HDR brachytherapy and IMRT in the treatment of early stage prostate cancer, particularly because a number of patients received androgen deprivation therapy and we delivered a higher biologically effective dose with combined modality therapy.
分析高剂量率（HDR）近距离放射治疗联合调强放射治疗（IMRT）与单纯IMRT治疗前列腺癌的效果。
2003年10月至2008年8月期间，284例早期前列腺癌患者接受了2200cGy的HDR近距离放射治疗及5040cGy的IMRT（n = 240），或单纯7920 - 8100cGy的IMRT（n = 44）。
中位随访时间为2.2年。放疗技术在糖尿病患者比例（p = 0.07）或接受激素治疗患者比例（p = 0.75）方面无显著差异。接受HDR近距离放射治疗联合IMRT的低危、中危和高危患者的3年无生化复发生存率分别为100%、98%和93%。单纯接受IMRT的低危、中危和高危患者的3年无生化复发生存率分别为100%、100%和67%。治疗组之间在无生化复发生存率或毒性方面无显著差异。仅检查未接受过激素治疗的患者时，治疗组之间的结果相似性保持不变。
HDR近距离放射治疗联合IMRT与单纯IMRT在无生化复发生存率和毒性方面相似。因此，我们继续根据医生和患者的偏好来确定治疗方案。更长时间的随访将有助于确定HDR近距离放射治疗和IMRT在早期前列腺癌治疗中的作用，特别是因为一些患者接受了雄激素剥夺治疗，并且我们通过联合治疗方式给予了更高的生物学有效剂量。
