Strom Tobin J, Hutchinson Sean Z, Shrinath Kushagra, Cruz Alex A, Figura Nicholas B, Nethers Kevin, Biagioli Matthew C, Fernandez Daniel C, Heysek Randy V, Wilder Richard B
Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Int Braz J Urol. 2014 Jul-Aug;40(4):474-83. doi: 10.1590/S1677-5538.IBJU.2014.04.05.
To assess outcomes with external beam radiation therapy (EBRT) and a low-dose-rate (LDR) brachytherapy boost without or with androgen deprivation therapy (ADT) for prostate cancer.
From January 2001 through August 2011, 120 intermediate-risk or high-risk prostate cancer patients were treated with EBRT to a total dose of 4,500 cGy in 25 daily fractions and a palladium-103 LDR brachytherapy boost of 10,000 cGy (n = 90) or an iodine-125 LDR brachytherapy boost of 11,000 cGy (n = 30). ADT, consisting of a gonadotropin-releasing hormone agonist ± an anti-androgen, was administered to 29/92 (32%) intermediate-risk patients for a median duration of 4 months and 26/28 (93%) high-risk patients for a median duration of 28 months.
Median follow-up was 5.2 years (range, 1.1-12.8 years). There was no statistically-significant difference in biochemical disease-free survival (bDFS), distant metastasis-free survival (DMFS), or overall survival (OS) without or with ADT. Also, therewas no statistically-significant difference in bDFS, DMFS, or OS with a palladium-103 vs. an iodine-125 LDR brachytherapy boost.
There was no statistically-significant difference in outcomes with the addition of ADT, though the power of the current study was limited. The Radiation Therapy Oncology Group 0815 and 0924 phase III trials, which have accrual targets of more than 1,500 men, will help to clarify the role ADT in locally-advanced prostate cancer patients treated with EBRT and a brachytherapy boost. Palladium-103 and iodine- 125 provide similar bDFS, DMFS, and OS.
评估外照射放疗（EBRT）联合低剂量率（LDR）近距离放疗增敏，无论有无雄激素剥夺治疗（ADT）时前列腺癌的治疗效果。
2001年1月至2011年8月，120例中危或高危前列腺癌患者接受EBRT，总剂量4500 cGy，分25次每日照射，同时接受10000 cGy的钯-103 LDR近距离放疗增敏（n = 90）或11000 cGy的碘-125 LDR近距离放疗增敏（n = 30）。29/92例（32%）中危患者接受了由促性腺激素释放激素激动剂±抗雄激素组成的ADT，中位持续时间为4个月；26/28例（93%）高危患者接受了ADT，中位持续时间为28个月。
中位随访时间为5.2年（范围1.1 - 12.8年）。有无ADT时，生化无病生存期（bDFS）、远处转移无病生存期（DMFS）或总生存期（OS）均无统计学显著差异。此外，钯-103与碘-125 LDR近距离放疗增敏时，bDFS、DMFS或OS也无统计学显著差异。
尽管本研究的效能有限，但加用ADT后的治疗效果无统计学显著差异。放射肿瘤学组0815和0924三期试验纳入目标超过1500例男性患者，这将有助于阐明ADT在接受EBRT和近距离放疗增敏的局部晚期前列腺癌患者中的作用。钯-103和碘-125的bDFS、DMFS和OS相似。
