Frank Steven J, Arterbery V Elayne, Hsu I-Chow Joe, Abdel-Wahab May, Ciezki Jay P, Hahn Noah M, Mohler James Lloyd, Moran Brian J, Rosenthal Seth A, Rossi Carl J, Yamada Yoshiya, Merrick Gregory
Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Brachytherapy. 2011 Sep-Oct;10(5):357-62. doi: 10.1016/j.brachy.2011.01.014. Epub 2011 Apr 16.
Permanent prostate brachytherapy has emerged as a standard of care treatment for approximately 50,000 men annually who present with clinically localized prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with permanent prostate brachytherapy.
Panel members with expertise on prostate cancer were assembled and provided several clinical scenarios for consensus treatment and management guidelines. Prostate cancer patient vignettes were presented along with specific management recommendations based on an extensive review of the modern brachytherapy literature. The brachytherapy topic development and review consists of two parts which require extensive participation by the expert panel. The American College of Radiology (ACR) Appropriateness Criteria (AC) are derived from a multidisciplinary panel of experts from both the academic and private practice settings. The first activity is a review of the current literature with development of an evidence table, referenced narrative, and ratings table of treatments. The second activity is the consensus-building process using a modified Delphi technique via an anonymous voting process.
Most brachytherapy series have demonstrated favorable morbidity profiles and durable biochemical control rates for patients with low-, intermediate-, and high-risk features. However, as brachytherapy followups have matured, it has become increasingly apparent that efficacy and morbidity are highly dependent on implant quality.
Continued attempts to refine patient selection, brachytherapy treatment planning philosophy, technique, and postimplant management should result in further improvements in biochemical outcome and decreased brachytherapy-related morbidity.
永久性前列腺近距离放射治疗已成为每年约5000例临床局限性前列腺癌男性患者的标准治疗方法。本综述的目的是阐明永久性前列腺近距离放射治疗前列腺癌的适用标准和管理考量。
召集了具有前列腺癌专业知识的小组成员，并提供了几种临床病例，以制定共识性治疗和管理指南。展示了前列腺癌患者的病例，并根据对现代近距离放射治疗文献的广泛综述给出了具体的管理建议。近距离放射治疗主题的制定和综述包括两个部分，需要专家小组广泛参与。美国放射学会（ACR）的适宜性标准（AC）源自学术和私人执业环境中的多学科专家小组。第一项活动是对当前文献进行综述，制定证据表、参考文献叙述和治疗评级表。第二项活动是通过匿名投票过程使用改良的德尔菲技术进行共识建立过程。
大多数近距离放射治疗系列研究表明，对于具有低、中、高风险特征的患者，其发病率情况良好，生化控制率持久。然而，随着近距离放射治疗随访的成熟，越来越明显的是，疗效和发病率高度依赖于植入质量。
持续尝试优化患者选择、近距离放射治疗计划理念、技术和植入后管理，应能进一步改善生化结果，并降低与近距离放射治疗相关的发病率。
