Cosset J-M, Hannoun-Lévi J-M, Peiffert D, Delannes M, Pommier P, Pierrat N, Nickers P, Thomas L, Chauveinc L
Département d'oncologie/radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
Cancer Radiother. 2013 Apr;17(2):111-7. doi: 10.1016/j.canrad.2013.01.009. Epub 2013 Mar 9.
With an experience of more than 25 years for the pioneers (and more than 14 years in France), permanent implant brachytherapy using iodine 125 seeds (essentially) is now recognized as a valuable alternative therapy for localized low-risk prostate cancer patients. The possible extension of the indications of exclusive brachytherapy towards selected patients in the intermediate-risk group has now been confirmed by several studies. Moreover, for the other patients in the intermediate-risk group and for the patients in the high-risk group, brachytherapy, as an addition to external radiotherapy, could represent one of the best ways to escalate the dose. Different permanent implant brachytherapy techniques have been proposed; preplanning or real-time procedure, loose or stranded seeds (or both), manual or automatic injection of the seeds. The main point here is the ability to perfectly master the procedure and to comply with the dosimetric constraints, which have been recently redefined by the international societies, such as the GEC-ESTRO group. Mid- and long-term results, which are now available in the literature, indicate relapse-free survival rates of about 90% at 5-10 years, the best results being obtained with satisfactory dosimetric data. Comparative data have shown that the incontinence and impotence rates after brachytherapy seemed to be significantly inferior to what is currently observed after surgery. However, a risk of about 3 to 5% of urinary retention is usually reported after brachytherapy, as well as an irritative urinary syndrome, which may significantly alter the quality of life of the patients, and last several months. In spite of those drawbacks, with excellent long-term results, low rates of incontinence and impotence, and emerging new indications (focal brachytherapy, salvage brachytherapy after localized failure of an external irradiation), permanent implant prostate brachytherapy can be expected to be proposed to an increasing number of patients in the next future.
对于先驱者而言，永久性植入近距离放射疗法已有超过25年的经验（在法国超过14年），使用碘125种子（主要是）的永久性植入近距离放射疗法现在被认为是局部低风险前列腺癌患者的一种有价值的替代疗法。多项研究现已证实，对于中风险组中选定的患者，单纯近距离放射疗法的适应证可能会扩大。此外，对于中风险组的其他患者和高风险组的患者，近距离放射疗法作为外照射放疗的补充，可能是提高剂量的最佳方法之一。已经提出了不同的永久性植入近距离放射疗法技术；预规划或实时操作、松散或成串种子（或两者皆有）、手动或自动植入种子。这里的关键是能够完美掌握操作并符合剂量学限制，国际社会（如GEC-ESTRO组）最近重新定义了这些限制。目前文献中可获得的中长期结果表明，5至10年的无复发生存率约为90%，剂量学数据令人满意时可获得最佳结果。比较数据表明，近距离放射疗法后的尿失禁和阳痿发生率似乎明显低于目前手术观察到的发生率。然而，通常报道近距离放射疗法后有3%至5%的尿潴留风险，以及刺激性尿路综合征，这可能会显著改变患者的生活质量，并持续数月。尽管有这些缺点，但由于长期效果良好、尿失禁和阳痿发生率低以及新出现的适应证（聚焦近距离放射疗法、外照射局部失败后的挽救性近距离放射疗法），预计在未来永久性植入前列腺近距离放射疗法将被越来越多的患者采用。
