Department of Radiation Oncology, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY.
Department of Urology, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY.
Urol Oncol. 2014 Jan;32(1):38.e1-7. doi: 10.1016/j.urolonc.2013.03.004. Epub 2013 Jun 13.
To present our treatment algorithm and 20-year experience in treating prostate cancer with brachytherapy since 1990, with focus on cancer-control outcomes and treatment-related morbidity.
We selected patients treated for localized prostate cancer with brachytherapy, combination therapy with external beam radiotherapy, and adjuvant androgen deprivation therapy as prescribed by our Mount Sinai risk stratification and treatment algorithm. Outcomes were analyzed with respect to biochemical failure, distant metastases, prostate cancer-specific survival, and overall survival. Morbidity was assessed with respect to urinary, sexual, and rectal outcomes.
In total, 2,495 patients met inclusion criteria. The 12-year actuarial freedom from biochemical failure was 83% (low risk: 90%, intermediate risk: 84%, and high risk: 64%); freedom from distant metastasis was 95%; prostate cancer-specific survival was 95%; and overall survival was 70%. On multivariate analysis, significant associations were found between cancer control and risk group, total biologically effective dose, and androgen deprivation therapy. With regard to morbidity, potency was preserved in 61%, and urinary symptoms improved in 35%. The 12-year actuarial freedom from urinary retention events was 90% and from severe rectal bleed was 93%.
Brachytherapy, as administered via the Mount Sinai algorithm, remains an efficacious and benign treatment option for patients with localized prostate cancer of all risk groups.
介绍自 1990 年以来，我们应用放射性粒子植入治疗局限性前列腺癌的治疗方案和 20 年的经验，重点关注癌症控制结果和与治疗相关的发病率。
我们选择了根据西奈山风险分层和治疗方案，接受放射性粒子植入治疗、外照射联合治疗和辅助雄激素剥夺治疗的局限性前列腺癌患者。分析了生化失败、远处转移、前列腺癌特异性生存和总生存的结果。评估了尿、性和直肠相关并发症的发病率。
共纳入 2495 例患者。12 年生化无失败的累积生存率为 83%（低危组：90%，中危组：84%，高危组：64%）；无远处转移的累积生存率为 95%；前列腺癌特异性生存率为 95%；总生存率为 70%。多因素分析显示，癌症控制与风险组、总生物有效剂量和雄激素剥夺治疗显著相关。关于发病率，61%的患者保留了勃起功能，35%的患者改善了尿症状。12 年尿潴留事件和严重直肠出血的累积无事件生存率分别为 90%和 93%。
放射性粒子植入治疗作为一种有效的治疗方法，根据西奈山算法治疗所有风险组的局限性前列腺癌，具有良好的疗效和安全性。
