Atallah V, Leduc N, Creoff M, Sargos P, Taouil T, Escarmant P, Vinh-Hung V
Department of Radiation Oncology, University Hospital of Martinique, Fort-de-France, France.
Department of Radiation Oncology, University Hospital of Martinique, Fort-de-France, France.
Brachytherapy. 2017 Mar-Apr;16(2):342-347. doi: 10.1016/j.brachy.2016.11.006. Epub 2016 Dec 23.
Prostate cancer is the most frequent malignancy in African-Caribbean men, a population sharing common genetic traits with African-American (AA) but presenting also genomic and epidemiologic specificities. Despite socioeconomic disparities with French mainland, all patients were treated within the French state-financed equal-access health care system. In this study, we report biochemical outcomes of patients treated by brachytherapy in our department from 2005 to 2014 in an African-Caribbean population.
Three hundred seventy consecutive patients receiving I brachytherapy as a curative treatment for early-stage (localized) disease between 2005 and 2014 were recorded. Selected patients presented with low-risk disease: initial prostate-specific antigen (PSA) <10 ng/mL, clinical stage ≤ T2c, and Gleason score <7. Patients with intermediate risk of recurrence were also included on a case-to-case basis with prostate-specific antigen <15 or Gleason score 7 (3 + 4). Biochemical failure free-survival was defined according to the American Society for Radiation Oncology nadir+2 definition.
The 3-year and 5-year biochemical failure free-survival for the entire cohort were 98.3% and 91.6%, respectively. For patients with low- and intermediate-risk disease, the 5-year BBFS rates were 92.1% and 90.8%, respectively. In univariate and multivariate analyses, only Gleason score (<7 vs. 7; p = 0.030 vs. p < 0.05) was a significant predictor of biochemical failure. The overall rate of late and acute Grade 2 or higher genitourinary toxicity was 12.6% and 10.3%.
In this large single-center series, brachytherapy achieved excellent rates of medium-term biochemical control in both low and selected intermediate-risk localized prostate cancer in African-Caribbean patients. Brachytherapy seems to be an excellent choice of treatment, with excellent outcomes and limited morbidity for African-Caribbean populations.
前列腺癌是非洲裔加勒比男性中最常见的恶性肿瘤，该人群与非裔美国人（AA）具有共同的遗传特征，但也表现出基因组和流行病学的特异性。尽管与法国本土存在社会经济差异，但所有患者均在法国国家资助的平等获取医疗保健系统内接受治疗。在本研究中，我们报告了2005年至2014年在我们科室接受近距离放射治疗的非洲裔加勒比人群患者的生化结果。
记录了2005年至2014年间连续370例接受近距离放射治疗作为早期（局限性）疾病根治性治疗的患者。入选患者表现为低风险疾病：初始前列腺特异性抗原（PSA）<10 ng/mL，临床分期≤T2c，Gleason评分<7。复发风险为中度的患者也根据具体情况纳入，前列腺特异性抗原<15或Gleason评分为7（3 + 4）。生化无失败生存期根据美国放射肿瘤学会最低点+2定义确定。
整个队列的3年和5年生化无失败生存率分别为98.3%和91.6%。对于低风险和中度风险疾病的患者，5年生化无失败生存率分别为92.1%和90.8%。在单因素和多因素分析中，只有Gleason评分（<7与7；p = 0.030与p < 0.05）是生化失败的显著预测因素。晚期和急性2级或更高等级泌尿生殖系统毒性的总体发生率分别为12.6%和10.3%。
在这个大型单中心系列研究中，近距离放射治疗在非洲裔加勒比患者的低风险和部分中度风险局限性前列腺癌中均实现了优异的中期生化控制率。对于非洲裔加勒比人群，近距离放射治疗似乎是一种极佳的治疗选择，具有优异的疗效和有限的发病率。
