Tétreault-Laflamme Audrey, Zilli Thomas, Meissner Aliza, Larrivée Sandra, Sylvestre Marie-Pierre, Delouya Guila, Taussky Daniel
Département de Radio-Oncologie, Centre hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, Canada; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Canada.
Division of Radiation Oncology, Geneva University Hospital, Switzerland.
Radiother Oncol. 2014 Apr;111(1):110-3. doi: 10.1016/j.radonc.2014.01.017. Epub 2014 Feb 20.
To study a four-point combined analysis (Quadrella) of optimal outcome among patients treated with exclusive permanent seed prostate brachytherapy (PB), as defined by the likelihood of achieving disease control and preserving normal urinary, gastro-intestinal (GI) and sexual function.
384 patients with localized prostate cancer underwent PB at our institution with (125)I at a dose level of 144Gy. Subjects with erectile dysfunction who did not respond to medication were excluded. 281 patients with minimum 3-year follow-up were evaluated. Patients with concurrent biochemical progression-free survival (bPFS), absent urinary and GI toxicities (grade 0 toxicities according to CTCAE v 3.0) and preserved sexual potency (with our without medication) were classified as the Quadrella group.
Among the 281 patients analyzed, the Quadrella was achieved in 49.1%, 48.0%, 50.4%, 41.7% and 65.2% in years 3-7, respectively. bPFS rates were 82.6-96.1%, corresponding potency rates were 63.6-82.3%, and normal urinary and GI function rates were 64.8-82.6% and 95-100%, respectively. By multivariate analysis, significant predictors of Quadrella were age (p=0.015), baseline IPSS (p=0.03) and time since PB (p=0.02).
Urinary and sexual toxicity remained the most common reasons for excluding patients from a perfect outcome (Quadrella), defined by strict criteria. This analysis can be useful for subsequent comparison between treatment modalities.
研究单纯永久性粒子植入前列腺近距离放射治疗（PB）患者的四点联合分析（Quadrella），该分析依据疾病控制可能性以及保留正常泌尿、胃肠（GI）和性功能来定义最佳结局。
384例局限性前列腺癌患者在我院接受了剂量为144Gy的¹²⁵I粒子植入PB治疗。排除对药物治疗无反应的勃起功能障碍患者。对281例至少随访3年的患者进行了评估。将同时具备生化无进展生存（bPFS）、无泌尿和GI毒性（根据CTCAE v 3.0为0级毒性）且保留性功能（无论是否使用药物）的患者归为Quadrella组。
在分析的281例患者中，第3 - 7年达到Quadrella的比例分别为49.1%、48.0%、50.4%、41.7%和65.2%。bPFS率为82.6 - 96.1%，相应的性功能保留率为63.6 - 82.3%，正常泌尿和GI功能率分别为64.8 - 82.6%和95 - 100%。多因素分析显示，Quadrella的显著预测因素为年龄（p = 0.015）、基线国际前列腺症状评分（IPSS）（p = 0.03）以及PB后的时间（p = 0.02）。
泌尿和性功能毒性仍然是按照严格标准定义的完美结局（Quadrella）中排除患者的最常见原因。该分析有助于后续不同治疗方式之间的比较。
