Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California 94115, USA.
Int J Radiat Oncol Biol Phys. 2012 Nov 15;84(4):962-7. doi: 10.1016/j.ijrobp.2012.01.043. Epub 2012 Apr 9.
To determine whether post-treatment prostate-specific antigen (ptPSA) values at 12 months and other clinical parameters predict long-term PSA relapse-free survival (PRFS) following prostate seed brachytherapy.
Records of 204 hormone-naïve patients with localized adenocarcinoma of the prostate treated at St. Mary's Regional Medical Center in Reno, NV, and at Carson Tahoe Regional Medical Center in Carson City, NV, between 1998 and 2003, using I-125 or Pd-103 seed brachytherapy, were retrospectively analyzed. Treatment planning was done using a preplanned, modified peripheral loading technique. A total of 185 of 204 patients had PSA records at 12 months after implant. Variables included were age, initial pretreatment PSA, Gleason score, T stage, National Comprehensive Cancer Network (NCCN) risk group (RG), perineural invasion (PNI), external beam boost, dose, and ptPSA levels at 12 months with cutpoints at ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml.
Median follow-up was 80 months, and median age was 69 years. The numbers of patients stratified by NCCN low, intermediate, and high RG were 110:65:10, respectively. Monotherapy and boost prescription doses were 145 Gy and 110 Gy for I-125, and 125 Gy and 100 Gy for Pd-103 seeds, respectively. The median dose (D90) was 95.4% of the prescribed dose. The 5-year PRFS at the 12-months ptPSA levels of ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml were 98.5%, 85.7%, 61.5%, and 22.2%, respectively. The 10-year PRFS at the 12-months ptPSA levels of ≤1 and 1.01 to 2.00 ng/ml were 90.5% and 85.7%, respectively. In multivariate analysis, both ptPSA and PNI were significant independent predictors of PRFS. Hazard ratios (HR) for ptPSA levels at ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml at 12 months were 1, 4.96, 27.57, and 65.10, respectively. PNI had an HR of 6.1 (p=0.009).
Presence of PNI and ptPSA values at 12 months are strong prognostic variables for long-term PRFS after definitive prostate brachytherapy seed implantation.
确定治疗后 12 个月的前列腺特异性抗原（ptPSA）值和其他临床参数是否可预测前列腺种子近距离放射治疗后长期 PSA 无复发生存（PRFS）。
回顾性分析了 1998 年至 2003 年间在内华达州里诺市圣玛丽地区医疗中心和卡森市卡森塔霍地区医疗中心接受 I-125 或 Pd-103 种子近距离放射治疗的 204 例局部前列腺腺癌激素初治患者的记录。治疗计划采用预先规划的改良外周加载技术进行。204 例患者中有 185 例在植入后 12 个月有 PSA 记录。变量包括年龄、初始治疗前 PSA、Gleason 评分、T 分期、国家综合癌症网络（NCCN）风险组（RG）、神经周围侵犯（PNI）、外照射放疗、剂量和 12 个月时的 ptPSA 水平，截断值分别为≤1、1.01 至 2.00、2.01 至 3.00 和>3.00 ng/ml。
中位随访时间为 80 个月，中位年龄为 69 岁。NCCN 低、中、高 RG 分层患者分别为 110：65：10。I-125 的单药和增强处方剂量分别为 145 Gy 和 110 Gy，Pd-103 种子的分别为 125 Gy 和 100 Gy。中位剂量（D90）为处方剂量的 95.4%。12 个月时 ptPSA 水平分别为≤1、1.01 至 2.00、2.01 至 3.00 和>3.00 ng/ml 的患者 5 年 PRFS 分别为 98.5%、85.7%、61.5%和 22.2%。12 个月时 ptPSA 水平分别为≤1 和 1.01 至 2.00 ng/ml 的患者 10 年 PRFS 分别为 90.5%和 85.7%。多变量分析显示，ptPSA 和 PNI 均是 PRFS 的独立显著预测因子。12 个月时 ptPSA 水平分别为≤1、1.01 至 2.00、2.01 至 3.00 和>3.00 ng/ml 的 HR 分别为 1、4.96、27.57 和 65.10。PNI 的 HR 为 6.1（p=0.009）。
PNI 和 12 个月时的 ptPSA 值是前列腺近距离放射治疗种子植入后长期 PRFS 的有力预后变量。
