Department of Clinical Oncology, St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom.
Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):50-6. doi: 10.1016/j.ijrobp.2009.01.050.
This study reports the 10-year experience of permanent brachytherapy monotherapy at a single UK center.
Between March 1995 and September 2004, 1,298 patients underwent trans-rectal ultrasound (TRUS) planned transperineal brachytherapy delivering 145 Gy using I-125. No patient received supplemental external beam; 44.2% received neoadjuvant hormones. In 688, CT postimplant dosimetry was available. Outcome data were analyzed in terms of overall survival (OS), disease specific survival (DSS), and PSA relapse-free survival (PSA-RFS).
The mean age was 62.9 (range, 34-83) years. Median follow-up was 4.9 years (range, 2.03-11.7 years). OS and DSS were 85% and 95%, respectively, at 10 years. Twenty-one patients died from prostate cancer (1.6%) and 34 (2.5%) from unrelated causes. Seventy-four (5.7%) developed evidence of clinical failure. Overall PSA-RFS was 79.9% and 72.1% at 10 years (American Society for Therapeutic Radiology and Oncology [ASTRO] and Nadir+2 definitions, respectively). Higher presenting PSA or Gleason score and use of neoadjuvant hormones were associated with an increased risk of biochemical failure (p <0.01). Biochemical control was achieved in 86.4%, 76.7%, and 60.6% (ASTRO) and 72.3%, 73.5%, and 57.6% (Nadir+2) of patients in low-, intermediate-, and high-risk groups, respectively. Biochemical control was achieved in 88% of patients with D(90) > or =140 Gy and in 78% of patients with D(90) <140 Gy (p <0.01).
I-125 brachytherapy alone achieved excellent rates of medium-term biochemical control in both low- and selected intermediate-risk localized prostate cancer patients. Postimplant dosimetry improved with experience and longer follow-up, confirming the relationship of D(90) with biochemical control.
本研究报告了一家英国中心 10 年的永久性近距离放射治疗单药治疗经验。
1995 年 3 月至 2004 年 9 月，1298 例患者接受经直肠超声（TRUS）计划经会阴近距离放射治疗，采用 I-125 给予 145Gy。无患者接受补充外照射；44.2%的患者接受新辅助激素治疗。在 688 例患者中，有 CT 植入后剂量学资料。生存分析采用总生存（OS）、疾病特异性生存（DSS）和 PSA 无复发生存（PSA-RFS）。
平均年龄为 62.9（34-83）岁。中位随访时间为 4.9 年（2.03-11.7 年）。10 年时 OS 和 DSS 分别为 85%和 95%。21 例患者死于前列腺癌（1.6%），34 例死于非相关原因（2.5%）。74 例（5.7%）出现临床失败证据。10 年时总体 PSA-RFS 分别为 79.9%和 72.1%（美国放射治疗与肿瘤学会[ASTRO]和 Nadir+2 定义）。较高的初始 PSA 或 Gleason 评分和使用新辅助激素与生化失败风险增加相关（p<0.01）。低、中、高危组分别有 86.4%、76.7%和 60.6%（ASTRO）和 72.3%、73.5%和 57.6%（Nadir+2）的患者实现了生化控制。D90≥140Gy 的患者中有 88%实现了生化控制，D90<140Gy 的患者中有 78%实现了生化控制（p<0.01）。
I-125 单纯近距离放射治疗在低危和选择的中危局限性前列腺癌患者中均能达到优异的中期生化控制率。随着经验的积累和随访时间的延长，植入后剂量学得到改善，证实了 D90 与生化控制的关系。
