Izard Michael Anthony, Morris Lucinda May, Wan Wai-Yin, Martin Jarad
Department of Radiotherapy, Mater Hospital, North Sydney, New South Wales, Australia; Northern Clinical School, University of Sydney, New South Wales, Australia.
Brachytherapy. 2013 Nov-Dec;12(6):608-14. doi: 10.1016/j.brachy.2013.04.004. Epub 2013 May 7.
We report the long-term outcomes of pulse-dose rate (PDR) brachytherapy used in a nonstandard style (pseudo-PDR) with an high-dose rate brachytherapy technique in conjunction with external beam radiotherapy (EBRT) and hormonal manipulation on prostate cancer (PC).
We treated 253 patients with Stage T1-T3 N0M0 PC, between December 1999 and March 2006. All patients received neoadjuvant androgen deprivation for a median 6 months. Treatment consisted of three pulses of pseudo-PDR brachytherapy to a median dose of 18Gy with 50.4Gy in 28 fractions of EBRT.
At a median 6 years followup, (range, 1-11 years), 5-year overall survival was 92%, and PC-specific survival was 96%. The 5-year biochemical control (biochemical no evidence of disease) by the Phoenix definition for low-, intermediate-, and high-risk groups was 95%, 90%, and 71%, respectively (p<0.00001). At 6 years, the incidence of Radiotherapy Oncology Group Grade 2 and 3 genitourinary toxicity was 1% and 6%; Radiotherapy Oncology Group Grade 2 and 3 gastrointestinal toxicity was 4% and 0%. Erectile preservation at 3 years was 58%. The Phoenix definition best predicted clinical failure with a high specificity (94%).
Pseudo-PDR brachytherapy plus EBRT with limited neoadjuvant hormonal manipulation is an effective treatment option in localized PC, with minimal and tolerable morbidity and provides excellent control. This technique of a modified PDR-delivery technique appears as effective as high-dose rate therapy.
我们报告了一种非标准方式（伪脉冲剂量率，pseudo-PDR）的脉冲剂量率近距离放射治疗联合外照射放疗（EBRT）及激素治疗对前列腺癌（PC）的长期疗效。
1999年12月至2006年3月期间，我们治疗了253例T1-T3 N0M0期PC患者。所有患者均接受了中位时间为6个月的新辅助雄激素剥夺治疗。治疗包括三个伪脉冲剂量率近距离放射治疗疗程，中位剂量为18Gy，同时联合EBRT给予50.4Gy，分28次照射。
中位随访6年（范围1-11年），5年总生存率为92%，PC特异性生存率为96%。低、中、高危组按Phoenix标准定义的5年生化控制率（生化无疾病证据）分别为95%、90%和71%（p<0.00001）。6年时，放射肿瘤学组2级和3级泌尿生殖系统毒性发生率分别为1%和6%；放射肿瘤学组2级和3级胃肠道毒性发生率分别为4%和0%。3年时勃起功能保留率为58%。Phoenix标准对临床失败的预测特异性最高（94%）。
伪脉冲剂量率近距离放射治疗联合EBRT并辅以有限的新辅助激素治疗是局限性PC的一种有效治疗选择，发病率低且可耐受，并能提供良好的控制效果。这种改良的脉冲剂量率递送技术似乎与高剂量率治疗一样有效。
