Department of Urology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea.
Yonsei Med J. 2013 Sep;54(5):1207-13. doi: 10.3349/ymj.2013.54.5.1207.
To investigate the role of low dose rate (LDR) brachytherapy-based multimodal therapy in high-risk prostate cancer (PCa) and analyze its optimal indications.
We reviewed the records of 50 high-risk PCa patients [clinical stage ≥ T2c, prostate-specific antigen (PSA) >20 ng/mL, or biopsy Gleason score ≥ 8] who had undergone 125I LDR brachytherapy since April 2007. We excluded those with a follow-up period <3 years. Biochemical recurrence (BCR) followed the Phoenix definition. BCR-free survival rates were compared between the patients with Gleason score ≥ 9 and Gleason score ≤ 8.
The mean initial PSA was 22.1 ng/mL, and mean D90 was 244.3 Gy. During a median follow- up of 39.2 months, biochemical control was obtained in 72% (36/50) of the total patients; The estimated 3-year BCR-free survival was 92% for the patients with biopsy Gleason scores ≤ 8, and 40% for those with Gleason scores ≥ 9 (p<0.001). In Cox multivariate analysis, only Gleason score ≥ 9 was observed to be significantly associated with BCR (p=0.021). Acute and late grade ≥ 3 toxicities were observed in 20% (10/50) and 36% (18/50) patients, respectively.
Our results showed that 125I LDR brachytherapy-based multimodal therapy in high-risk PCa produced encouraging relatively long-term results among the Asian population, especially in patients with Gleason score ≤ 8. Despite small number of subjects, biopsy Gleason score ≥ 9 was a significant predictor of BCR among high risk PCa patients after brachytherapy.
探讨低剂量率（LDR）近距离放射治疗为基础的多模态治疗在高危前列腺癌（PCa）中的作用，并分析其最佳适应证。
我们回顾了自 2007 年 4 月以来接受 125I LDR 近距离放射治疗的 50 例高危 PCa 患者[临床分期≥T2c，前列腺特异性抗原（PSA）>20ng/mL 或活检 Gleason 评分≥8]的记录。我们排除了随访时间<3 年的患者。生化复发（BCR）采用 Phoenix 定义。比较了 Gleason 评分≥9 与 Gleason 评分≤8 的患者之间的 BCR 无复发生存率。
平均初始 PSA 为 22.1ng/mL，D90 为 244.3Gy。在中位随访 39.2 个月期间，总共有 72%（36/50）的患者获得了生化控制；活检 Gleason 评分≤8 的患者 3 年 BCR 无复发生存率为 92%，Gleason 评分≥9 的患者为 40%（p<0.001）。在 Cox 多变量分析中，仅 Gleason 评分≥9 与 BCR 显著相关（p=0.021）。20%（10/50）和 36%（18/50）的患者分别发生急性和晚期≥3 级毒性。
我们的结果表明，在亚洲人群中，125I LDR 近距离放射治疗为基础的多模态治疗对高危 PCa 产生了令人鼓舞的长期结果，特别是在 Gleason 评分≤8 的患者中。尽管研究对象数量较少，但在接受近距离放射治疗的高危 PCa 患者中，活检 Gleason 评分≥9 是 BCR 的显著预测因子。
