Pinto Francesco, Calarco Alessandro, Recupero Salvatore Marco, Totaro Angelo, Sacco Emilio, Bassi Pierfrancesco
Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico "A. Gemelli", Roma - Italy.
Urologia. 2013 Apr-Jun;80(2):87-98. doi: 10.5301/RU.2013.11285. Epub 2013 Jul 1.
Brachytherapy (BT), using either a low-dose-rate (LDR) or mostly high-dose-rate (HDR) technique, is the device able to deliver the highest dose-rate in the most conformal way. It is used as monotherapy or in combination with external beam radiotherapy (EBRT). LDR-BT is mostly used as monotherapy; HDR-BT is combined with EBRT ± adjuvant hormone therapy. In patients with low-risk disease and in selected intermediate-risk patients, LDR-BT ensures long-term good disease control rates and HDR-BT can show similar results, even if with shorter follow-up. In patients with intermediate/high risk disease the combination therapy (EBRT + HDR-BT) shows better oncological outcomes compared to EBRT monotherapy, even if the role of adjuvant hormone therapy is still unclear. Literature shows variable efficacy of BT in case of local recurrence after EBRT and radical prostatectomy even if few cases have been reported with short follow-up. Side effects are acceptable (urogenital toxicity, urinary incontinence, sexual function) and comparable with the other treatment modalities. So far, randomized controlled trials comparing the different treatment modalities are necessary to clarify indications and real efficacy.
近距离放射治疗（BT），采用低剂量率（LDR）或大多采用高剂量率（HDR）技术，是一种能够以最适形的方式提供最高剂量率的设备。它可作为单一疗法使用，或与外照射放疗（EBRT）联合使用。LDR - BT大多用作单一疗法；HDR - BT与EBRT ± 辅助激素治疗联合使用。在低风险疾病患者和部分中风险患者中，LDR - BT可确保长期良好的疾病控制率，HDR - BT即使随访时间较短也能显示出相似的结果。在中/高风险疾病患者中，联合治疗（EBRT + HDR - BT）与EBRT单一疗法相比显示出更好的肿瘤学结果，尽管辅助激素治疗的作用仍不明确。文献表明，在EBRT和根治性前列腺切除术后局部复发的情况下，BT的疗效存在差异，即使报道的病例很少且随访时间短。副作用是可接受的（泌尿生殖系统毒性、尿失禁、性功能），且与其他治疗方式相当。到目前为止，有必要进行比较不同治疗方式的随机对照试验，以明确适应证和实际疗效。
