Ohashi Toshio, Yorozu Atsunori, Saito Shiro, Momma Tetsuo, Nishiyama Toru, Yamashita Shoji, Shiraishi Yutaka, Shigematsu Naoyuki
Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Radiat Oncol. 2014 Jan 9;9:13. doi: 10.1186/1748-717X-9-13.
To report the outcomes of patients treated with combined iodine-125 (I-125) brachytherapy and external beam radiotherapy (EBRT) for high-risk prostate cancer.
Between 2003 and 2009, I-125 permanent prostate brachytherapy plus EBRT was performed for 206 patients with high-risk prostate cancer. High-risk patients had prostate-specific antigen ≥ 20 ng/mL, and/or Gleason score ≥ 8, and/or Stage ≥ T3. One hundred and one patients (49.0%) received neoadjuvant androgen deprivation therapy (ADT) but none were given adjuvant ADT. Biochemical failure-free survival (BFFS) was determined using the Phoenix definition.
The 5-year actuarial BFFS rate was 84.8%. The 5-year cause-specific survival and overall survival rates were 98.7% and 97.6%, respectively. There were 8 deaths (3.9%), of which 2 were due to prostate cancer. On multivariate analysis, positive biopsy core rates and the number of high-risk factors were independent predictors of BFFS. The 5-year BFFS rates for patients in the positive biopsy core rate <50% and ≥ 50% groups were 89.3% and 78.2%, respectively (p = 0.03). The 5-year BFFS rate for patients with the any single high-risk factor was 86.1%, compared with 73.6% for those with any 2 or all 3 high-risk factors (p = 0.03). Neoadjuvant ADT did not impact the 5-year BFFS.
At a median follow-up of 60 months, high-risk prostate cancer patients undergoing combined I-125 brachytherapy and EBRT without adjuvant ADT have a high probability of achieving 5-year BFFS.
报告接受碘-125（I-125）近距离放射治疗联合外照射放疗（EBRT）的高危前列腺癌患者的治疗结果。
2003年至2009年间，对206例高危前列腺癌患者实施了I-125永久性前列腺近距离放射治疗联合EBRT。高危患者的前列腺特异性抗原≥20 ng/mL，和/或 Gleason评分≥8，和/或分期≥T3。101例患者（49.0%）接受了新辅助雄激素剥夺治疗（ADT），但均未接受辅助ADT。采用Phoenix定义确定无生化复发生存率（BFFS）。
5年精算BFFS率为84.8%。5年特定病因生存率和总生存率分别为98.7%和97.6%。有8例死亡（3.9%），其中2例死于前列腺癌。多因素分析显示，活检阳性核心率和高危因素数量是BFFS的独立预测因素。活检阳性核心率<50%和≥50%组患者的5年BFFS率分别为89.3%和78.2%（p = 0.03）。具有任何单一高危因素的患者5年BFFS率为86.1%，而具有任何2个或所有3个高危因素的患者为73.6%（p = 0.03）。新辅助ADT不影响5年BFFS。
在中位随访60个月时，接受I-125近距离放射治疗联合EBRT且未接受辅助ADT的高危前列腺癌患者实现5年BFFS的可能性很高。
