Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK.
Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):1376-84. doi: 10.1016/j.ijrobp.2011.04.031. Epub 2011 Jun 15.
To evaluate genitourinary (GU) and gastrointestinal (GI) morbidity and biochemical control of disease in patients with localized prostate adenocarcinoma treated with escalating doses per fraction of high-dose rate brachytherapy alone.
A total of 197 patients were treated with 34 Gy in four fractions, 36 Gy in four fractions, 31.5 Gy in three fractions, or 26 Gy in two fractions. Median follow-up times were 60, 54, 36, and 6 months, respectively.
Incidence of early Grade ≥ 3 GU morbidity was 3% to 7%, and Grade 4 was 0% to 4%. During the first 12 weeks, the highest mean International Prostate Symptom Score (IPSS) value was 14, and between 6 months and 5 years it was 8. Grade 3 or 4 early GI morbidity was not observed. The 3-year actuarial rate of Grade 3 GU was 3% to 16%, and was 3% to 7% for strictures requiring surgery (4-year rate). An incidence of 1% Grade 3 GI events was seen at 3 years. Late Grade 4 GU or GI events were not observed. At 3 years, 99% of patients with intermediate-risk and 91% with high-risk disease were free of biochemical relapse (log-rank p = 0.02).
There was no significant difference in urinary and rectal morbidity between schedules. Biochemical control of disease in patients with intermediate and high risk of relapse was good.
评估单纯采用高剂量率近距离放射治疗递增剂量分割治疗局限性前列腺腺癌患者的泌尿生殖系统（GU）和胃肠道（GI）发病率和疾病生化控制情况。
共 197 例患者接受 34 Gy 分 4 次、36 Gy 分 4 次、31.5 Gy 分 3 次或 26 Gy 分 2 次治疗。中位随访时间分别为 60、54、36 和 6 个月。
早期≥3 级 GU 发病率为 3%至 7%，4 级发病率为 0%至 4%。在最初的 12 周内，最高平均国际前列腺症状评分（IPSS）值为 14，在 6 个月至 5 年内为 8。未观察到 3 级或 4 级早期 GI 发病率。3 年累积 3 级 GU 发生率为 3%至 16%，需要手术的狭窄发生率为 3%至 7%（4 年发生率）。3 年时观察到 1%的 3 级 GI 事件发生率。未观察到晚期 4 级 GU 或 GI 事件。3 年后，中危和高危疾病患者中有 99%和 91%无生化复发（对数秩检验 p=0.02）。
不同方案之间的泌尿和直肠发病率无显著差异。具有中危和高危复发风险的患者疾病的生化控制良好。
