Department of Radiotherapy, Centre of Oncology, M. Skłodowska - Curie Institute, Krakow Branch, ul. Garncarska 11, 31-115, Krakow, Poland,
Strahlenther Onkol. 2014 Feb;190(2):165-70. doi: 10.1007/s00066-013-0486-z. Epub 2013 Dec 8.
The aim of the present retrospective study is to evaluate toxicity and early clinical outcomes of interstitial hyperthermia (IHT) combined with high-dose rate (HDR) brachytherapy as a salvage treatment in patients with biopsy-confirmed local recurrence of prostate cancer after previous external beam radiotherapy.
Between September 2008 and March 2013, 25 patients with local recurrence of previously irradiated prostate cancer were treated. The main eligibility criteria for salvage prostate HDR brachytherapy combined with interstitial hyperthermia were biopsy confirmed local recurrence and absence of nodal and distant metastases. All patients were treated with a dose of 30 Gy in 3 fractions at 21-day intervals. We performed 62 hyperthermia procedures out of 75 planned (83 %). The aim of the hyperthermia treatment was to heat the prostate to 41-43 °C for 60 min. Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, v. 4.03). Determination of subsequent biochemical failure was based on the Phoenix definition (nadir + 2 ng/ml).
The median age was 71 years (range 62-83 years), the median initial PSA level was 16.3 ng/ml (range 6.37-64 ng/ml), and the median salvage PSA level was 2.8 ng/ml (1.044-25.346 ng/ml). The median follow-up was 13 months (range 4-48 months). The combination of HDR brachytherapy and IHT was well tolerated. The most frequent complications were nocturia, weak urine stream, urinary frequency, hematuria, and urgency. Grade 2 rectal hemorrhage was observed in 1 patient. No grade 3 or higher complications were observed. The 2-year Kaplan-Meier estimate of biochemical control after salvage treatment was 74 %. The PSA in 20 patients decreased below the presalvage level, while 11 patients achieved a PSA nadir < 0.5 ng/ml. All patients are still alive. Of the 7 patients who experienced biochemical failure, bone metastases were found in 2 patients.
IHT in combination with salvage HDR brachytherapy is a well tolerated and effective treatment.
本回顾性研究旨在评估间质高热（IHT）联合高剂量率（HDR）近距离放疗作为既往外照射放疗后前列腺癌局部复发患者的挽救性治疗的毒性和早期临床结果。
2008 年 9 月至 2013 年 3 月，共 25 例经活检证实的既往照射前列腺癌局部复发患者接受了治疗。挽救性前列腺 HDR 近距离放疗联合间质高热的主要入选标准为活检证实的局部复发，且无淋巴结和远处转移。所有患者均接受 30Gy，分 3 次，间隔 21 天。计划进行 75 次高温治疗，实际进行了 62 次（83%）。高温治疗的目的是将前列腺加热至 41-43°C，持续 60 分钟。根据通用不良事件术语标准（CTCAE，v. 4.03）评估泌尿生殖系统和直肠器官的毒性。根据凤凰定义（最低点+2ng/ml）确定随后的生化失败。
中位年龄为 71 岁（范围 62-83 岁），中位初始 PSA 水平为 16.3ng/ml（范围 6.37-64ng/ml），中位挽救性 PSA 水平为 2.8ng/ml（1.044-25.346ng/ml）。中位随访时间为 13 个月（范围 4-48 个月）。HDR 近距离放疗联合 IHT 耐受性良好。最常见的并发症为夜尿、尿流弱、尿频、血尿和尿急。1 例患者出现 2 级直肠出血。未观察到 3 级或更高的并发症。挽救性治疗后 2 年生化控制的 Kaplan-Meier 估计值为 74%。20 例患者的 PSA 降至挽救前水平以下，11 例患者的 PSA 最低点<0.5ng/ml。所有患者仍存活。在 7 例生化失败的患者中，2 例发现骨转移。
IHT 联合挽救性 HDR 近距离放疗是一种耐受良好且有效的治疗方法。
