Kotecha Rupesh, Yamada Yoshiya, Pei Xin, Kollmeier Marisa A, Cox Brett, Cohen Gil'ad N, Zaider Marco, Zelefsky Michael J
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Brachytherapy. 2013 Jan-Feb;12(1):44-9. doi: 10.1016/j.brachy.2012.05.003. Epub 2012 Jul 24.
To report prostate-specific antigen (PSA) relapse-free survival and treatment-related toxicity outcomes after combining high-dose-rate (HDR) brachytherapy with external beam radiotherapy (EBRT) for patients with clinically localized prostate cancer.
Between 1998 and 2009, 229 patients were treated with HDR brachytherapy followed 3 weeks later by supplemental EBRT. The HDR brachytherapy boost consisted of three fractions of (192)Ir (5.5-7.5Gy per fraction), and EBRT consisted of intensity-modulated radiotherapy delivering an additional 45.0-50.4Gy directed to the prostate gland and seminal vesicles. Median follow-up was 61 months.
Seven-year PSA relapse-free survival for low-, intermediate-, and high-risk patients were 95%, 90%, and 57%, respectively (p<0.001). Among high-risk patients treated with biological equivalent doses in excess of 190Gy, 7-year PSA relapse-free survival was 81%. In multivariate analysis, Gleason scores of ≥8 predicted for increased risk of biochemical failure, whereas the use of short-term neoadjuvant androgen deprivation therapy did not influence tumor-control outcomes even among intermediate- or high-risk patients. Seven-year incidence of distant metastases for low-, intermediate-, and high-risk patients were 5%, 3%, and 17%, respectively. Seven-year incidence of late Grade 2 and 3 genitourinary toxicities were 22.1% and 4.9%, respectively and the 7-year incidence of Grade 2 and 3 gastrointestinal toxicities were 1% and 0.4%, respectively.
HDR prostate brachytherapy in conjunction with supplemental EBRT results in excellent biochemical relapse-free survival rates with a low incidence of severe late genitourinary or gastrointestinal toxicities. The use of short-term neoadjuvant androgen deprivation did not influence long-term biochemical tumor control in this cohort.
报告高剂量率（HDR）近距离放射治疗联合外照射放疗（EBRT）治疗临床局限性前列腺癌患者后的无前列腺特异性抗原（PSA）复发生存率及治疗相关毒性结果。
1998年至2009年间，229例患者接受了HDR近距离放射治疗，3周后接受补充EBRT。HDR近距离放射治疗增敏包括3次（192）铱照射（每次5.5 - 7.5Gy），EBRT包括调强放疗，向前列腺和精囊额外给予45.0 - 50.4Gy。中位随访时间为61个月。
低、中、高危患者的7年无PSA复发生存率分别为95%、90%和57%（p<0.001）。在接受生物等效剂量超过190Gy治疗的高危患者中，7年无PSA复发生存率为81%。多因素分析中，Gleason评分≥8预示生化失败风险增加，而短期新辅助雄激素剥夺治疗即使在中高危患者中也不影响肿瘤控制结果。低、中、高危患者的7年远处转移发生率分别为5%、3%和17%。7年2级和3级泌尿生殖系统毒性发生率分别为22.1%和4.9%，7年2级和3级胃肠道毒性发生率分别为1%和0.4%。
HDR前列腺近距离放射治疗联合补充EBRT可带来优异的无生化复发生存率，严重晚期泌尿生殖系统或胃肠道毒性发生率低。在该队列中，短期新辅助雄激素剥夺治疗不影响长期生化肿瘤控制。
