Gastaldi Emilio, Gallo Fabrizio, Chiono Luciano, Giberti Claudio
Department of Urology, San Paolo Hospital, Savona - Italy.
Urologia. 2014 Jan-Mar;81(1):46-50. doi: 10.5301/urologia.5000034. Epub 2013 Nov 28.
To present our initial experience with brachytherapy (BT) as a primary salvage procedure for the treatment of prostate cancer (PCa) local recurrence following radical retropubic prostatectomy (RRP).
From December 2009 to May 2010, three patients underwent salvage BT due to local recurrences of high risk PCa after extrafascial RRP without additional adjuvant therapies. Local recurrence was confirmed by prostate biopsy and the relapse was well defined by endorectal ultrasonography and magnetic resonance imaging. Metastatic screening was negative. The patients were followed-up according to the American Brachytherapy Society guidelines.
The median dose delivered to 90% of the local relapse (D90) was 115 Gy. The three patients reached a prostate specific antigen (PSA) nadir value within the first year that remained stable at a mean follow-up of 32 months. As regards morbidity, moderate de novo urgency was reported by only one patient.
We think that our data confirms the feasibility and safety of salvage BT as a possible alternative option to external beam radiotherapy (EBRT) for the treatment of locally recurrent PCa in selected patients when performed by experienced centers. However, larger series of patients with longer follow-ups are needed to define the oncologic role of this procedure.
介绍我们将近距离放射治疗（BT）作为根治性耻骨后前列腺切除术（RRP）后前列腺癌（PCa）局部复发的主要挽救性治疗方法的初步经验。
2009年12月至2010年5月，3例高危PCa患者在筋膜外RRP术后出现局部复发，未接受额外辅助治疗，接受了挽救性BT。通过前列腺活检确认局部复发，经直肠超声和磁共振成像明确复发情况。转移筛查为阴性。根据美国近距离放射治疗学会指南对患者进行随访。
90%局部复发灶所接受的中位剂量（D90）为115 Gy。3例患者在第一年内前列腺特异性抗原（PSA）降至最低点，在平均32个月的随访期内保持稳定。关于并发症，仅1例患者报告有中度新发尿急。
我们认为，我们的数据证实了挽救性BT在经验丰富的中心进行时，作为外照射放疗（EBRT）的一种可能替代选择用于治疗特定患者局部复发PCa的可行性和安全性。然而，需要更大规模的患者系列和更长时间的随访来确定该治疗方法的肿瘤学作用。
