Morton Gerard C
Radiotherapy Department, Sunnybrook Odette Cancer Centre, University of Toronto, Canada.
J Contemp Brachytherapy. 2014 Oct;6(3):323-30. doi: 10.5114/jcb.2014.45759. Epub 2014 Oct 6.
High-dose-rate brachytherapy (HDR) is a method of conformal dose escalation to the prostate. It can be used as a local boost in combination with external beam radiotherapy, with a high degree of efficacy and low rate of long term toxicity. Data consistently reports relapse free survival rates of greater than 90% for intermediate risk patients and greater than 80% for high risk. Results are superior to those achieved with external beam radiotherapy alone. A wide range of dose and fractionation is reported, however, we have found that a single 15 Gy HDR combined with hypofractionated radiotherapy to a dose of 37.5 Gy in 15 fractions is well tolerated and is associated with a long term relapse-free survival of over 90%. Either CT-based or trans-rectal ultrasound-based planning may be used. The latter enables treatment delivery without having to move the patient with risk of catheter displacement. We have found it to be an efficient and quick method of treatment, allowing catheter insertion, planning, and treatment delivery to be completed in less than 90 minutes. High-dose-rate boost should be considered the treatment of choice for many men with high and intermediate risk prostate cancer.
高剂量率近距离放射疗法（HDR）是一种对前列腺进行适形剂量递增的方法。它可作为外照射放疗的局部增强手段，疗效显著且长期毒性发生率低。数据一致显示，中危患者的无复发生存率大于90%，高危患者大于80%。结果优于单纯外照射放疗。虽然有多种剂量和分割方式的报道，但我们发现，单次15 Gy的HDR联合15次分割至37.5 Gy的低分割放疗耐受性良好，且长期无复发生存率超过90%。可采用基于CT或经直肠超声的治疗计划。后者无需移动患者即可进行治疗，避免了导管移位的风险。我们发现它是一种高效快捷的治疗方法，导管插入、计划制定和治疗实施可在90分钟内完成。高剂量率增强放疗应被视为许多中高危前列腺癌男性患者的首选治疗方法。
