Sasaki Hiroshi, Kido Masahito, Miki Kenta, Kuruma Hidetoshi, Takahashi Hiroyuki, Aoki Manabu, Egawa Shin
Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
Int J Urol. 2014 Jun;21(6):572-7. doi: 10.1111/iju.12373. Epub 2013 Dec 23.
To characterize local recurrence of prostate cancer and to assess the effect of salvage partial brachytherapy after primary 125-iodine low-dose rate brachytherapy with or without external beam radiotherapy in Japanese men.
Between 2003 and 2010, a total of 616 consecutive patients underwent low-dose rate brachytherapy-based therapy for clinically localized prostate cancer at Jikei University Hospital in Tokyo, Japan. Biochemical recurrence occurred in 45 (7.3%) patients at a median of 30 months (range 11-93 months). A total of 20 patients subsequently underwent transperineal template prostatic biopsy; of those, eight had positive cores at the base of the prostate or at the seminal vesicles. These eight patients had underdosed areas identified at initial low-dose rate brachytherapy corresponding to the positive biopsy sites. All were confirmed to have only localized recurrence, and seven underwent salvage partial low-dose rate brachytherapy.
Median prostate-specific antigen nadir level in the eight patients with biopsy-proven local recurrence after initial low-dose rate brachytherapy was 0.75 ng/mL (range 0.39-2.06). The seven retreated patients tolerated the salvage partial low-dose rate brachytherapy well, and showed a decrease in prostate-specific antigen level at follow up. Two patients later developed biochemical and clinical progression at 11 and 13 months, respectively. Prostate-specific antigen level continued to be low in the remaining five patients. No significant genitourinary or gastrointestinal toxicity was encountered.
Salvage partial low-dose rate brachytherapy for biopsy-proven localized prostate cancer recurrence appears rational, technically feasible and safe. Optimal patient selection is of utmost importance for long-term success. Larger studies with longer follow up are warranted.
描述前列腺癌的局部复发情况，并评估在日本男性中，初次进行¹²⁵碘低剂量率近距离放射治疗联合或不联合外照射放疗后，挽救性部分近距离放射治疗的效果。
2003年至2010年期间，日本东京慈惠会医科大学医院共有616例连续患者接受了基于低剂量率近距离放射治疗的临床局限性前列腺癌治疗。45例（7.3%）患者出现生化复发，中位时间为30个月（范围11 - 93个月）。随后共有20例患者接受了经会阴模板引导的前列腺穿刺活检；其中8例在前列腺基部或精囊处穿刺结果为阳性。这8例患者在初次低剂量率近距离放射治疗时，对应活检阳性部位存在剂量不足区域。所有患者均被证实仅为局部复发，7例患者接受了挽救性部分低剂量率近距离放射治疗。
初次低剂量率近距离放射治疗后经活检证实局部复发的8例患者，前列腺特异性抗原最低水平的中位数为0.75 ng/mL（范围0.39 - 2.06）。7例接受再次治疗的患者对挽救性部分低剂量率近距离放射治疗耐受性良好，随访时前列腺特异性抗原水平下降。2例患者分别在11个月和13个月后出现生化和临床进展。其余5例患者的前列腺特异性抗原水平持续较低。未出现明显的泌尿生殖系统或胃肠道毒性。
对于经活检证实的局限性前列腺癌复发，挽救性部分低剂量率近距离放射治疗似乎合理、技术上可行且安全。最佳的患者选择对于长期成功至关重要。有必要进行更大规模、更长随访时间的研究。
