Chiumento Costanza, Montagna Antonietta, Clemente Stefania, Cozzolino Mariella, Fusco Vincenzo
Department of Radiation Oncology, IRCCS-CROB, Rionero in Vulture (PZ), Italy.
Tumori. 2011 May-Jun;97(3):335-40. doi: 10.1177/030089161109700313.
To evaluate the biochemical disease-free survival (bDFS) rate after (125)I permanent-implant prostate brachytherapy.
Patients with a diagnosis of prostate adenocarcinoma and adequate PSA follow-up were selected for this retrospective study. Brachytherapy with permanent (125)I seeds was performed as monotherapy, with a prescribed dose of 145 Gy to the prostate. Patients were stratified into recurrence risk groups according to the National Comprehensive Cancer Network (NCCN) guidelines. Biochemical failure was defined using the American Society of Therapeutic Radiology and Oncology (ASTRO) guidelines. The post-implant D90 (defined as the minimum dose covering 90% of the prostate) was obtained for each patient. Two cutoff points were used to test the correlation between D90 and bDFS results: 130 Gy and 140 Gy. bDFS was calculated from the implant date to the date of biochemical recurrence. Univariate and multivariate analysis were performed using the SPSS software and included clinical stage, pretreatment PSA, Gleason score (GS), androgen deprivation therapy, D90, and risk groups. In the univariate analysis we used a cutoff point of 5.89 ng/mL for PSA and 5 for GS.
From June 2003 to April 2007, 70 patients were analyzed. The patients' distribution into recurrence risk groups was as follows: 39 patients (56%) in the low-risk group, 23 patients (33%) in the intermediate-risk group, and 8 patients (11%) in the high-risk group. At a median follow-up of 47 months (range, 19-70 months) bDFS was 88.4%, with a global actuarial 5-year bDFS of 86%. Disease-related factors including initial PSA level, GS and risk group were significant predictors of biochemical failure ( P = 0.01, P = 0.01, P = 0.006, respectively). In multivariate analysis, risk group (P = 0.005) and GS (P = 0.03) were statistically significant.
Our data are in agreement with those in the literature and, despite the short follow-up, confirm the advantage of brachytherapy for patients at low and intermediate risk of recurrence.
评估碘-125永久性植入前列腺近距离放射治疗后的生化无病生存率（bDFS）。
选取诊断为前列腺腺癌且前列腺特异抗原（PSA）随访充分的患者进行这项回顾性研究。采用永久性碘-125粒子进行近距离放射治疗作为单一疗法，前列腺的处方剂量为145 Gy。根据美国国立综合癌症网络（NCCN）指南将患者分层为复发风险组。使用美国放射肿瘤学会（ASTRO）指南定义生化失败。为每位患者获取植入后D90（定义为覆盖90%前列腺的最小剂量）。使用两个截断点来检验D90与bDFS结果之间的相关性：130 Gy和140 Gy。bDFS从植入日期计算至生化复发日期。使用SPSS软件进行单因素和多因素分析，分析因素包括临床分期、治疗前PSA、 Gleason评分（GS）、雄激素剥夺治疗、D90和风险组。在单因素分析中，我们将PSA的截断点设为5.89 ng/mL，GS的截断点设为5。
2003年6月至2007年4月，对70例患者进行了分析。患者在复发风险组中的分布如下：低风险组39例（56%），中风险组23例（33%），高风险组8例（11%）。中位随访47个月（范围19 - 70个月），bDFS为88.4%，总体精算5年bDFS为86%。包括初始PSA水平、GS和风险组在内的疾病相关因素是生化失败的显著预测因素（分别为P = 0.01、P = 0.01、P = 0.006）。在多因素分析中，风险组（P = 0.005）和GS（P = 0.03）具有统计学意义。
我们的数据与文献中的数据一致，尽管随访时间短，但证实了近距离放射治疗对低和中度复发风险患者的优势。
