Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
Int J Radiat Oncol Biol Phys. 2012 Jul 15;83(4):1154-9. doi: 10.1016/j.ijrobp.2011.09.055. Epub 2012 Jan 21.
This population-based analysis compared prostate cancer-specific mortality (PCSM) in a cohort of patients with high-risk prostate cancer after nonsurgical treatment with external beam radiation therapy (EBRT), brachytherapy (BT), or combination (BT + EBRT).
We identified from the Surveillance, Epidemiology and End Results database patients diagnosed from 1988 through 2002 with T1-T3N0M0 prostate adenocarcinoma of poorly differentiated grade and treated with BT, EBRT, or BT + EBRT. During this time frame, the database defined high grade as prostate cancers with Gleason score 8-10, or Gleason grade 4-5 if the score was not recorded. This corresponds to a cohort primarily with high-risk prostate cancer, although some cases where only Gleason grade was recorded may have included intermediate-risk cancer. We used multivariate models to examine patient and tumor characteristics associated with the likelihood of treatment with each radiation modality and the effect of radiation modality on PCSM.
There were 12,745 patients treated with EBRT (73.5%), BT (7.1%), or BT + EBRT (19.4%) included in the analysis. The median follow-up time for all patients was 6.4 years. The use of BT or BT + EBRT increased from 5.1% in 1988-1992 to 31.4% in 1998-2002. Significant predictors of use of BT or BT + EBRT were younger age, later year of diagnosis, urban residence, and earlier T-stage. On multivariate analysis, treatment with either BT (hazard ratio, 0.66; 95% confidence interval, 0.49-0.86) or BT + EBRT (hazard ratio, 0.77; 95% confidence ratio, 0.66-0.90) was associated with significant reduction in PCSM compared with EBRT alone.
In patients with high-grade prostate cancer, treatment with brachytherapy is associated with reduced PCSM compared with EBRT alone. Our results suggest that brachytherapy should be investigated as a component of definitive treatment strategies for patients with high-risk prostate cancer.
本基于人群的分析比较了非手术治疗（外照射放射治疗[EBRT]、近距离放射治疗[BT]或联合治疗[BT+EBRT]）后高危前列腺癌患者队列中的前列腺癌特异性死亡率（PCSM）。
我们从监测、流行病学和最终结果数据库中确定了 1988 年至 2002 年间诊断为 T1-T3N0M0 前列腺腺癌、接受 BT、EBRT 或 BT+EBRT 治疗的患者。在此期间，数据库将高级别定义为前列腺癌的 Gleason 评分 8-10，或如果未记录评分，则为 Gleason 分级 4-5。这对应于一个主要是高危前列腺癌的队列，尽管一些仅记录 Gleason 分级的病例可能包括中危癌症。我们使用多变量模型来检查与每种放射治疗模式的治疗可能性相关的患者和肿瘤特征，以及放射治疗模式对 PCSM 的影响。
分析中包括 12745 例接受 EBRT（73.5%）、BT（7.1%）或 BT+EBRT（19.4%）治疗的患者。所有患者的中位随访时间为 6.4 年。BT 或 BT+EBRT 的使用比例从 1988-1992 年的 5.1%增加到 1998-2002 年的 31.4%。BT 或 BT+EBRT 使用的显著预测因素是年龄较小、诊断年份较晚、居住在城市和较早的 T 期。多变量分析显示，与单独接受 EBRT 相比，BT（风险比，0.66；95%置信区间，0.49-0.86）或 BT+EBRT（风险比，0.77；95%置信区间，0.66-0.90）治疗与 PCSM 显著降低相关。
在高级别前列腺癌患者中，与单独接受 EBRT 相比，BT 治疗与降低 PCSM 相关。我们的结果表明，应将 BT 作为高危前列腺癌患者确定性治疗策略的一部分进行研究。
