Kwon E D, Loening S A, Hawtrey C E
Department of Urology, University of Iowa Hospitals and Clinics, Iowa City.
J Urol. 1991 Mar;145(3):524-31. doi: 10.1016/s0022-5347(17)38387-8.
Between 1977 and 1988, 131 patients with adenocarcinoma of the prostate underwent combined radical prostatectomy and intraoperative radioactive gold seed placement. Of these 131 patients 80 were clinically assessed as having stage A2 (12), B1 (43) or B2 (25) cancer and they are the subject of this review. The average dose of radioactivity administered to each patient was 96.6 mCi, and mean followup was 65 months (median 64 months). No patient in this series received any other form of adjuvant therapy until disease recurrence was demonstrated. Local recurrences were observed in 2 patients (2.5%) in this series while distant recurrences were observed in 10 (12.5%). Cancer specific survival free of disease at 5 years was 100% for clinical stage A2, 91% for B1 and 75% for B2 cancers. The 10-year survival free of disease was 100% for clinical stage A2, 82% for B1 and 68% for B2 cancers. Covariants of clinical stage and seminal vesicle involvement influenced survival free of disease in a statistically significant manner (p less than 0.05) while pathological stage and degree of tumor differentiation did not. Mild to severe complications were observed in 12 patients (15%). Intraoperative placement of radioactive gold seeds into unresected pelvic tissues surrounding the site of prostatectomy offers a theoretical advantage in treatment by delivering tumoricidal levels of irradiation to residual foci of cancer not appreciated at the time of surgery. Our results suggest that increases in cancer specific survival free of disease over that previously reported for prostatectomy alone may be achieved through this combined treatment regimen. Furthermore, it is our opinion that therapeutic gains can be achieved without the attendant increases in morbidity and treatment delay often associated with adjuvant external beam radiotherapy.
1977年至1988年间，131例前列腺癌患者接受了前列腺癌根治术联合术中放射性金种子植入治疗。在这131例患者中，80例经临床评估为A2期（12例）、B1期（43例）或B2期（25例）癌症，他们是本综述的研究对象。每位患者接受的平均放射性剂量为96.6毫居里，平均随访时间为65个月（中位数64个月）。在本系列研究中，直到证实疾病复发，没有患者接受任何其他形式的辅助治疗。本系列中有2例患者（2.5%）出现局部复发，10例患者（12.5%）出现远处复发。临床A2期癌症5年无病特异性生存率为100%，B1期为91%，B2期为75%。临床A2期癌症10年无病生存率为100%，B1期为82%，B2期为68%。临床分期和精囊受累的协变量对无病生存率有统计学意义的影响（p小于0.05），而病理分期和肿瘤分化程度则没有。12例患者（15%）出现了轻度至重度并发症。术中将放射性金种子植入前列腺切除部位周围未切除的盆腔组织中，通过向手术时未发现的残留癌灶提供杀肿瘤水平的辐射，在治疗上具有理论优势。我们的结果表明，通过这种联合治疗方案，可以实现比以前单独前列腺切除术报告的更高的癌症特异性无病生存率。此外，我们认为，在不增加通常与辅助外照射放疗相关的发病率和治疗延迟的情况下，可以实现治疗效果的提高。
