Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Urology. 2011 Jun;77(6):1416-9. doi: 10.1016/j.urology.2011.02.011. Epub 2011 Apr 13.
To present our initial experience with brachytherapy used as a salvage procedure for local recurrence of prostate cancer in the prostatic fossa after radical prostatectomy.
The patients included 5 consecutive men who underwent brachytherapy as a salvage procedure after radical prostatectomy from December 2006 to March 2008. We used a technique of implanting the local recurrences similar to the American Brachytherapy Society Guidelines for implanting an intact prostate as definitive therapy. Two modifications were made related to the recurrence location: a rare need to manage urethral doses because the recurrence was typically perirectal, and more aggressive management of the dose to the rectum because of this proximity.
All patients tolerated the brachytherapy procedure well and showed a decline in the prostate-specific antigen level, with a median nadir of 0.72 ng/mL at a median follow-up of 13 months. The postprocedural symptoms were minor and included limited new-onset urgency. At the last follow-up visit, all patients had prostate-specific antigen doubling times, which have been associated with long median survival times.
Salvage brachytherapy for biopsy-proven local recurrence of prostate cancer is a technically feasible alternative to external beam radiotherapy for local control of recurrences in the prostatic fossa in selected patients after radical prostatectomy.
介绍我们在根治性前列腺切除术后前列腺窝局部复发的前列腺癌患者中，采用近距离放射治疗作为挽救性治疗的初步经验。
2006 年 12 月至 2008 年 3 月，连续 5 例患者接受了近距离放射治疗作为挽救性治疗。我们采用了一种类似于美国近距离放射治疗学会指南中对完整前列腺进行确定性治疗的植入局部复发灶的技术。由于复发灶通常位于直肠周围，因此与复发灶位置相关的有两个改进：一种是由于复发灶位置特殊，很少需要管理尿道剂量；另一种是因为这种接近程度，对直肠剂量的管理更加积极。
所有患者均能很好地耐受近距离放射治疗，前列腺特异性抗原水平下降，中位随访 13 个月时中位值为 0.72ng/ml。术后症状轻微，包括新出现的有限的尿急。在最后一次随访时，所有患者的前列腺特异性抗原倍增时间均延长，这与较长的中位生存时间有关。
对于经活检证实的根治性前列腺切除术后前列腺窝局部复发的患者，近距离放射治疗作为挽救性治疗，对于选择的患者来说，是一种替代外照射放射治疗以局部控制复发灶的可行技术。
