Berkshire Cancer Centre, Royal Berkshire NHS Foundation Trust, Reading, UK.
BJU Int. 2012 Aug;110(3):383-90. doi: 10.1111/j.1464-410X.2012.10931.x. Epub 2012 Feb 14.
• To report the results of real-time brachytherapy in the management of low-risk and intermediate-risk prostate cancer in patients with prostate volumes up to 100 mL, over a 6-year period. • To prospectively determine whether prostate volume influences the ability to achieve a quality implant and therefore impact upon prostate-specific antigen (PSA) relapse-free survival, and urinary and rectal toxicity.
• In all, 216 men with localized prostate cancer were treated with real-time prostate brachytherapy using (125) I implants between November 2003 and December 2009. • Patient selection was based upon functional parameters; International Prostate Symptom Score (IPSS) and flowmetry. • Patients had computed tomography imaging at 1 month to assess post-implant dosimetry. PSA, IPSS and Radiation Therapy Oncology Group rectal toxicity scores were recorded prospectively over the follow-up period. • Patients with prostate volumes ≤50 mL and those with volumes >50 mL were compared.
• Overall PSA relapse-free survival was 98.8%; 97.0% for intermediate-risk patients and 100.0% for low-risk patients. By volume, 98.5% of men with standard prostates were free from PSA relapse compared with 100.0% of men with large prostates. • The mean post-implant D90 was 177.0 Gy; 175.5 Gy in standard prostates and 183.5 Gy in large prostates. • The overall acute urinary retention rate was 1.9%; 1.7% in standard prostates and 2.4% in large prostates. There were three urethral strictures, all in the standard prostate group. The mean IPSS increased to 11 and 14 at 3 months for the standard and large prostate groups, respectively, before settling to 2 above baseline for both groups at 12 months. • There were no rectovesical fistulae. Persistent rectal bleeding was reported by one (0.5%) patient in the standard prostate group.
• Prostate brachytherapy is effective in the treatment of low-risk and intermediate-risk prostate cancer. • It is technically possible to deliver a quality implant in a large prostate using real-time brachytherapy. • The treatment itself is well tolerated. Prostate volumes up to 100 mL should not exclude patients from brachytherapy providing either flow rate ≥14 mL/s or symptom score (IPSS) ≤ 10.
报告在前列腺体积达 100 毫升的低危和中危前列腺癌患者中，使用实时近距离放射治疗的结果，随访时间为 6 年。
前瞻性确定前列腺体积是否影响实现高质量种植体的能力，从而影响前列腺特异性抗原（PSA）无复发生存率以及尿和直肠毒性。
2003 年 11 月至 2009 年 12 月期间，对 216 名局部前列腺癌患者采用（125）I 植入实时前列腺近距离放射治疗。
患者选择基于功能参数；国际前列腺症状评分（IPSS）和流量测量。
患者在 1 个月时进行计算机断层扫描成像以评估植入后剂量。前瞻性记录 PSA、IPSS 和放射治疗肿瘤学组直肠毒性评分的随访期。
比较前列腺体积≤50ml 和体积＞50ml 的患者。
总体 PSA 无复发生存率为 98.8%；中危患者为 97.0%，低危患者为 100.0%。按体积计算，标准前列腺的 98.5%男性无 PSA 复发，而大前列腺的 100.0%男性无 PSA 复发。
植入后平均 D90 为 177.0Gy；标准前列腺为 175.5Gy，大前列腺为 183.5Gy。
总的急性尿潴留发生率为 1.9%；标准前列腺为 1.7%，大前列腺为 2.4%。标准前列腺组有 3 例尿道狭窄，均有 1 例（0.5%）患者发生直肠出血。标准和大前列腺组在 3 个月时的 IPSS 分别增加到 11 和 14，12 个月时两组均稳定在基线以上 2 分。
无直肠膀胱瘘。
前列腺近距离放射治疗是治疗低危和中危前列腺癌的有效方法。
使用实时近距离放射治疗技术可以为大前列腺提供高质量的种植体。
治疗本身耐受性良好。前列腺体积达 100ml 不应排除接受流量率≥14ml/s 或症状评分（IPSS）≤10 的患者进行近距离放射治疗。
