Western Radiation Oncology, Mountain View, California, USA.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):e225-32. doi: 10.1016/j.ijrobp.2011.04.046. Epub 2011 Jun 12.
Recent publications have suggested high-risk patients undergoing radical prostatectomy have a lower risk of distant metastases and improved cause-specific survival (CSS) than patients receiving definitive external beam radiation therapy (XRT). To date, none of these studies has compared distant metastases and CSS in brachytherapy patients. In this study, we evaluate such parameters in a consecutive cohort of brachytherapy patients.
From April 1995 to June 2007, 1,840 consecutive patients with clinically localized prostate cancer were treated with brachytherapy. Risk groups were stratified according to National Comprehensive Cancer Network (www.nccn.org) guidelines. Subgroups of 658, 893, and 289 patients were assigned to low, intermediate, and high-risk categories. Median follow-up was 7.2 years. Along with brachytherapy implantation, 901 (49.0%) patients received supplemental XRT, and 670 (36.4%) patients received androgen deprivation therapy (median duration, 4 months). The mode of failure (biochemical, local, or distant) was determined for each patient for whom therapy failed. Cause of death was determined for each deceased patient. Multiple parameters were evaluated for impact on outcome.
For the entire cohort, metastases-free survival (MFS) and CSS at 12 years were 98.1% and 98.2%, respectively. When rates were stratified by low, intermediate, and high-risk groups, the 12-year MFS was 99.8%, 98.1%, and 93.8% (p < 0.001), respectively. CSS rates were 99.8%, 98.0%, and 95.3% (p < 0.001) for low, intermediate, and high-risk groups, respectively. Biochemical progression-free survival was 98.7%, 95.9% and 90.4% for low, intermediate, and high-risk patients, respectively (p < 0.001). In multivariate Cox-regression analysis, MFS was mostly closely related to Gleason score and year of treatment, whereas CSS was most closely associated with Gleason score.
Excellent CSS and MFS rates are achievable with high-quality brachytherapy for low, intermediate, and high-risk patients. These results compare favorably to alternative treatment modalities. In particular, our MFS and CSS rates for high-risk patients appear superior to those of published radical prostatectomy series.
最近的出版物表明，接受根治性前列腺切除术的高危患者发生远处转移的风险较低，并且特异性生存（CSS）得到改善。迄今为止，尚无研究比较近距离放射治疗（Brachytherapy）患者的远处转移和 CSS。在这项研究中，我们评估了连续队列中接受近距离放射治疗的患者的这些参数。
从 1995 年 4 月至 2007 年 6 月，1840 例临床局限性前列腺癌患者接受了近距离放射治疗。根据国家综合癌症网络（www.nccn.org）指南，将风险组分层。658、893 和 289 例患者分别归入低、中、高危组。中位随访时间为 7.2 年。除了近距离放射治疗植入物外，901 例（49.0%）患者接受了补充外部束放射治疗，670 例（36.4%）患者接受了雄激素剥夺治疗（中位持续时间为 4 个月）。对于每个治疗失败的患者，均确定了失败的模式（生化，局部或远处）。对于每个死亡患者，均确定了死亡原因。评估了多个参数对结果的影响。
对于整个队列，无转移生存（MFS）和 12 年 CSS 分别为 98.1%和 98.2%。当按低，中，高危组分层时，12 年 MFS 分别为 99.8%，98.1%和 93.8%（p <0.001）。低，中，高危组的 CSS 率分别为 99.8%，98.0%和 95.3%（p <0.001）。低，中，高危患者的生化无进展生存率分别为 98.7%，95.9%和 90.4%（p <0.001）。多变量 Cox 回归分析表明，MFS 主要与 Gleason 评分和治疗年份密切相关，而 CSS 与 Gleason 评分最密切相关。
对于低，中，高危患者，高质量的近距离放射治疗可实现出色的 CSS 和 MFS 率。这些结果与替代治疗方式相比具有优势。特别是，我们对高危患者的 MFS 和 CSS 率似乎优于已发表的根治性前列腺切除术系列。
