Martin T, Wenz F, Böhmer D, Sedlmayer F, Hinkelbein W, Henkel T O, Miller K, Wiegel T
Klinik für Strahlentherapie, Klinikum Bremen-Mitte, St.-Jürgen-Strasse 1, 28205 Bremen.
Urologe A. 2010 Feb;49(2):216-20. doi: 10.1007/s00120-010-2242-7.
Postoperative adjuvant radiation therapy has achieved special significance based on the results of three randomized studies on stage pT3R1 prostate cancer which provided evidence for prolonged survival in comparison to the "wait and see" strategy. When PSA levels persist or increase after radical prostatectomy, irradiation represents an alternative. In this instance, salvage radiotherapy should be initiated as early as possible, most suitably when the PSA level is <0.5 ng/ml. Side effects of percutaneous radiotherapy using modern techniques are minimal in this stage; severe grade 3 or 4 late sequelae occur in <3% of cases. Low dose rate (LDR) brachytherapy as monotherapy is a primary treatment option for low-risk tumors. In patients with intermediate-risk tumors, data are controversial and cannot be assessed conclusively. LDR brachytherapy should not be administered in high-risk tumors. High dose rate (HDR) brachytherapy combined with percutaneous radiotherapy as an example of a typical dose escalation approach is a primary option for intermediate- and high-risk prostate cancer. Whether additional hormone therapy is needed with HDR brachytherapy is unclear. HDR monotherapy can only be recommended in the clinical trial setting.
基于三项关于pT3R1期前列腺癌的随机研究结果，术后辅助放疗具有特殊意义，这些研究表明与“观察等待”策略相比，其能延长生存期。根治性前列腺切除术后若PSA水平持续或升高，放疗是一种选择。在此情况下，挽救性放疗应尽早开始，最适宜在PSA水平<0.5 ng/ml时进行。在这个阶段，采用现代技术的经皮放疗副作用极小；严重的3级或4级晚期后遗症发生率<3%。低剂量率（LDR）近距离放疗作为单一疗法是低风险肿瘤的主要治疗选择。对于中风险肿瘤患者，数据存在争议且无法最终评估。高风险肿瘤不应采用LDR近距离放疗。高剂量率（HDR）近距离放疗联合经皮放疗作为典型的剂量递增方法的一个例子，是中高危前列腺癌的主要选择。HDR近距离放疗是否需要额外的激素治疗尚不清楚。HDR单一疗法仅在临床试验环境中可被推荐。
