Hoskin Peter, Rojas Ana, Ostler Peter, Hughes Robert, Alonzi Roberto, Lowe Gerry, Bryant Linda
Cancer Centre, Mount Vernon Hospital, Northwood, UK.
Cancer Centre, Mount Vernon Hospital, Northwood, UK.
Radiother Oncol. 2014 Jul;112(1):63-7. doi: 10.1016/j.radonc.2014.06.007. Epub 2014 Jul 10.
To evaluate late urinary (GU) and gastrointestinal (GI) adverse events (AEs) and biochemical control of disease after high-dose rate brachytherapy (HDR-BT) in locally advanced prostate cancer.
227 consecutive patients were treated with 3 × 10.5 Gy (n = 109) or 2 × 13 Gy (n = 118) HDR-BT alone. Biochemical failure was assessed using the Phoenix definition of PSA nadir + 2 μg/l and late AEs using the RTOG scoring system and the International Prostate Symptom Score (IPSS).
Kaplan-Meier estimates and prevalence of late events indicate that urinary, bowel and IPSS symptoms are higher after 31.5 Gy than after 26 Gy, however differences are significant only for Grade 1 and 2 urinary toxicity. Kaplan-Meier estimates of morbidity are consistently and considerably higher than time-point estimates of prevalence; which reflects the transient nature of most symptoms. At 3 years 93% and 97% of patients treated with 26 and 31.5 Gy, respectively, were free from biochemical relapse (p = 0.5) and 91% for the latter regimen at 5 years. In univariate and multivariate analysis risk-category was the only significant predictor of relapse (p < 0.03).
These HDR-BT schedules achieved high levels of biochemical control of disease in patients with advanced prostate cancer with few severe complications seen throughout the first 3 years.
评估局部晚期前列腺癌高剂量率近距离放射治疗（HDR-BT）后晚期泌尿系统（GU）和胃肠道（GI）不良事件（AE）以及疾病的生化控制情况。
227例连续患者接受了单独的3×10.5 Gy（n = 109）或2×13 Gy（n = 118）HDR-BT治疗。使用PSA最低点+2μg/l的Phoenix定义评估生化失败情况，使用RTOG评分系统和国际前列腺症状评分（IPSS）评估晚期不良事件。
Kaplan-Meier估计值和晚期事件患病率表明，31.5 Gy后泌尿系统、肠道和IPSS症状高于26 Gy后，但仅1级和2级泌尿系统毒性差异显著。Kaplan-Meier发病率估计值始终且显著高于患病率的时间点估计值；这反映了大多数症状的短暂性。3年时，接受26 Gy和31.5 Gy治疗的患者分别有93%和97%无生化复发（p = 0.5），后者方案在5年时为91%。在单因素和多因素分析中，风险类别是复发的唯一显著预测因素（p < 0.03）。
这些HDR-BT方案在晚期前列腺癌患者中实现了高水平的疾病生化控制，在最初3年中几乎未见严重并发症。
