预处理和治疗因素对前列腺近距离放射治疗后中期至长期结果的影响。

Influence of pretreatment and treatment factors on intermediate to long-term outcome after prostate brachytherapy.

机构信息

Department of Urology, Mount Sinai School of Medicine, New York, New York, USA.

出版信息

J Urol. 2011 Feb;185(2):495-500. doi: 10.1016/j.juro.2010.09.099. Epub 2010 Dec 17.

DOI:10.1016/j.juro.2010.09.099

PMID:21167528

Abstract

PURPOSE

We describe how treatment factors influence biochemical freedom from failure, local control, freedom from metastasis and cause specific survival in patients treated with prostate brachytherapy.

MATERIALS AND METHODS

We followed 2,111 men who underwent brachytherapy a median of 6 years (range 2 to 17). Median prostate specific antigen was 7 ng/ml. Of the men 1,455 (68.9%) had clinical stage T2a or less and 1,428 (67.6%) had Gleason score less than 7. A total of 1,171 patients (55.5%) received (125)I, 221 (10.4%) received (103)Pd and 719 (34.1%) received supplemental external beam irradiation combined with (103)Pd. Post-implant dosimetry was done 30 days after implantation with doses converted to the biologically effective dose. Prostate biopsy was done 2 years after permanent prostate brachytherapy in 586 men (27.8%). Survival functions were determined by the Kaplan-Meier method and Cox regression with proportions tested by the log rank test.

RESULTS

The 12-year biochemical freedom from failure rate was 78.6%, and stage, Gleason score, prostate specific antigen and biologically effective dose were significant predictors (p = 0.007, <0.001, 0.005 and <0.001, respectively). In 964 patients at low risk the biochemical freedom from failure rate was 88.1% and significant predictors were hormonal therapy (p = 0.030), prostate specific antigen (p = 0.026) and biologically effective dose (p = 0.003). In 499 patients at intermediate risk the biochemical freedom from failure rate was 79.2% with biologically effective dose a significant predictor (p <0.001). In 648 men at high risk the biochemical freedom from failure rate was 67% and significant predictors were hormonal therapy, Gleason score and biologically effective dose (p = 0.036, <0.001 and 0.012, respectively). The local failure rate was 7.3% with biologically effective dose a significant predictor (p <0.001). Prostate biopsy was positive in 21 of 121 cases (21.5%) for a biologically effective dose of 150 Gy2 or less, in 14 of 248 (5.6%) for greater than 150 to 200 Gy2 and in 3 of 193 (1.6%) for greater than 200 Gy2 (p <0.001). The 12-year freedom from metastasis rate was 95.2% with Gleason score a significant predictor (p <0.001). Cause specific survival at 12 years was 94.5% with Gleason score and biologically effective dose significant predictors (p <0.001 and 0.027, respectively).

CONCLUSIONS

Permanent prostate brachytherapy yields excellent long-term oncologic outcomes. High biologically effective dose may need to be delivered to achieve successful biochemical freedom from failure, local control and cause specific survival.

摘要

目的

我们描述了治疗因素如何影响接受前列腺近距离放射治疗的患者的生化无失败、局部控制、无转移和特定原因生存。

材料与方法

我们随访了 2111 名中位年龄为 6 岁（范围为 2 至 17 岁）接受近距离放射治疗的男性。中位前列腺特异性抗原为 7ng/ml。其中 1455 名（68.9%）患者临床分期为 T2a 或更低，1428 名（67.6%）患者 Gleason 评分低于 7。共有 1171 名患者（55.5%）接受了（125）I、221 名（10.4%）接受了（103）Pd 和 719 名（34.1%）接受了补充外照射与（103）Pd 联合治疗。植入后 30 天进行植入后剂量学检查，剂量转换为生物有效剂量。在 586 名男性（27.8%）中，在永久性前列腺近距离放射治疗后 2 年进行前列腺活检。生存功能通过 Kaplan-Meier 方法和 Cox 回归确定，比例通过对数秩检验进行测试。

结果

12 年生化无失败率为 78.6%，分期、Gleason 评分、前列腺特异性抗原和生物有效剂量是显著的预测因素（p=0.007、<0.001、0.005 和 <0.001，分别）。在低危的 964 名患者中，生化无失败率为 88.1%，有显著预测因素的是激素治疗（p=0.030）、前列腺特异性抗原（p=0.026）和生物有效剂量（p=0.003）。在中危的 499 名患者中，生化无失败率为 79.2%，生物有效剂量是显著的预测因素（p<0.001）。在高危的 648 名男性中，生化无失败率为 67%，有显著预测因素的是激素治疗、Gleason 评分和生物有效剂量（p=0.036、<0.001 和 0.012，分别）。局部失败率为 7.3%，生物有效剂量是显著的预测因素（p<0.001）。在生物有效剂量为 150Gy2 或以下的 121 例中有 21 例（21.5%）前列腺活检阳性，在生物有效剂量为 150 至 200Gy2 的 248 例中有 14 例（5.6%），在生物有效剂量大于 200Gy2 的 193 例中有 3 例（1.6%）（p<0.001）。12 年无转移率为 95.2%，Gleason 评分是显著的预测因素（p<0.001）。12 年特定原因生存率为 94.5%，Gleason 评分和生物有效剂量是显著的预测因素（p<0.001 和 0.027，分别）。