Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama Shi, Wakayama 641-0012, Japan.
Cancers (Basel). 2011 Sep 14;3(3):3585-600. doi: 10.3390/cancers3033585.
The purpose of this study was to evaluate the efficacy and safety of high-dose-rate (HDR) brachytherapy of a single implant with two fractions plus external beam radiotherapy (EBRT) for hormone-naïve prostate cancer in comparison with radical prostatectomy. Of 150 patients with localized prostate cancer (T1c-T2c), 59 underwent HDR brachytherapy plus EBRT, and 91 received radical prostatectomy. The median follow-up of patients was 62 months for HDR brachytherapy plus EBRT, and 64 months for radical prostatectomy. In patient backgrounds between the two cohorts, the frequency of T2b plus T2c was greater in HDR brachytherapy cohort than in prostatectomy cohort (27% versus 12%, p = 0.029). Patients in HDR brachytherapy cohort first underwent 3D conformal RT with four beams to the prostate to an isocentric dose of 50 Gy in 25 fractions and then, a total of 15-18 Gy in two fractions at least 5 hours apart. We prescribed 9 Gy/fraction for target (prostate gland plus 3 mm lateral outside margin and seminal vesicle) using CT image method for radiation planning. The total biochemical failure-free control rates (BF-FCR) at 3 and 5 years for the HDR brachytherapy cohort, and for the prostatectomy cohort were 92% and 85%, and 72% and 72%, respectively (significant difference, p = 0.0012). The 3-and 5-year BF-FCR in the HDR brachytherapy cohort and in the prostatectomy cohort by risk group was 100 and 100%, and 80 and 80%, respectively, for the low-risk group (p = 0.1418); 92 and 92%, 73 and 73%, respectively, for the intermediate-risk group (p = 0.0492); and 94 and 72%, 45 and 45%, respectively, for the high-risk group (p = 0.0073). After HDR brachytherapy plus EBRT, no patient experienced Grade 2 or greater genitourinay toxicity. The rate of late Grade 1 and 2 GI toxicity was 6% (n = 4). No patient experienced Grade 3 GI toxicity. HDR brachytherapy plus EBRT is useful for treating patients with hormone-naïve localized prostate cancer, and has low GU and GI toxicities.
这项研究的目的是评估对于激素初治局限性前列腺癌，高剂量率（HDR）近距离治疗单次植入 2 次分割加外照射放疗（EBRT）与根治性前列腺切除术的疗效和安全性。在 150 例局限性前列腺癌（T1c-T2c）患者中，59 例行 HDR 近距离治疗加 EBRT，91 例行根治性前列腺切除术。HDR 近距离治疗加 EBRT 组患者的中位随访时间为 62 个月，根治性前列腺切除术组为 64 个月。在两组患者的背景中，HDR 近距离治疗组 T2b 加 T2c 的发生率高于前列腺切除术组（27%比 12%，p = 0.029）。HDR 近距离治疗组患者首先接受 3D 适形放疗，4 束照射前列腺，等中心剂量为 50 Gy，25 次分割，然后至少相隔 5 小时进行 2 次分割，每次 15-18 Gy。我们使用 CT 图像法为放疗计划规定 9 Gy/分次的靶区（前列腺加 3 mm 侧方外边界和精囊）处方剂量。HDR 近距离治疗组和前列腺切除术组的总生化无失败控制率（BF-FCR）在 3 年和 5 年时分别为 92%和 85%，72%和 72%（差异有统计学意义，p = 0.0012）。HDR 近距离治疗组和前列腺切除术组的低危组的 3 年和 5 年 BF-FCR 分别为 100%和 100%，73%和 73%（p = 0.1418）；中危组分别为 92%和 92%，73%和 73%（p = 0.0492）；高危组分别为 94%和 72%，45%和 45%（p = 0.0073）。HDR 近距离治疗加 EBRT 后，无患者发生 2 级或更高级别的泌尿生殖毒性。迟发性 1 级和 2 级胃肠道毒性的发生率为 6%（n = 4）。无患者发生 3 级胃肠道毒性。HDR 近距离治疗加 EBRT 对治疗激素初治局限性前列腺癌有效，且具有较低的 GU 和 GI 毒性。
