Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY, USA.
Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1338-44. doi: 10.1016/j.ijrobp.2009.06.061.
To describe long-term outcomes and toxicity after salvage brachytherapy (BT) for local failure after initial radiotherapy for prostate cancer.
Between 1994 and 2008, 37 men with local failure after initial prostate radiotherapy (32 external-beam radiation therapy [EBRT] and 5 BT) underwent salvage BT with (103)Pd or (125)I. Estimates of freedom from biochemical failure (FFbF, Phoenix definition) and cause-specific survival (CSS) were calculated using the Kaplan-Meier method. Toxicities were graded using CTCv3.0.
Median follow-up was 86 months (range, 2-156). The median dose to 90% of the prostate volume was 122 Gy (range, 67-166). The 10-year FFbF and CSS were 54% and 96%, respectively. On univariate analysis, prostate-specific antigen (PSA) >10 ng/mL at initial diagnosis was significantly associated with FFbF (p = 0.01), and there were trends for both age <70 years (p = 0.08) and PSA <6 ng/mL (p = 0.08) at the time of salvage BT. On multivariate analysis, only presalvage PSA <6 ng/mL (p = 0.046) was significantly associated with improved FFbF. There were three Grade 3 toxicities and one Grade 4 toxicity. Pelvic lymph node dissection before salvage BT was the only variable significantly associated with Grade > or = 2 toxicity (p = 0.03).
With a median follow-up of 86 months, salvage prostate BT was associated with a 10-year FFbF of 54% and CSS of 96%. Improved FFbF was associated with a presalvage PSA <6 ng/mL. Toxicity was worse in patients who had undergone pelvic lymph node dissection before salvage BT. Careful patient selection for salvage BT may result in improved outcomes and reduced toxicity.
描述初始前列腺放射治疗后局部失败的补救性近距离放射治疗（BT）后的长期结果和毒性。
1994 年至 2008 年间，37 名初始前列腺放射治疗后局部复发的患者（32 例外照射放射治疗 [EBRT] 和 5 例 BT）接受了补救性 BT，使用 (103)Pd 或 (125)I。使用 Kaplan-Meier 法计算生化无失败（FFbF，凤凰定义）和特定原因生存（CSS）的估计值。毒性使用 CTCv3.0 进行分级。
中位随访时间为 86 个月（范围 2-156）。前列腺 90%体积的中位剂量为 122 Gy（范围 67-166）。10 年 FFbF 和 CSS 分别为 54%和 96%。单因素分析显示，初始诊断时 PSA>10ng/mL 与 FFbF 显著相关（p=0.01），且在补救性 BT 时 PSA<6ng/mL（p=0.08）和年龄<70 岁（p=0.08）的趋势。多因素分析显示，仅补救性 BT 前 PSA<6ng/mL（p=0.046）与 FFbF 改善显著相关。有 3 例 3 级毒性和 1 例 4 级毒性。补救性 BT 前盆腔淋巴结清扫是唯一与≥2 级毒性显著相关的变量（p=0.03）。
中位随访 86 个月后，补救性前列腺 BT 与 10 年 FFbF 为 54%和 CSS 为 96%相关。FFbF 改善与补救性 BT 前 PSA<6ng/mL 相关。补救性 BT 前接受盆腔淋巴结清扫的患者毒性更严重。对补救性 BT 进行仔细的患者选择可能会改善结果并降低毒性。
