Okamoto Keisei, Wada Akinori, Kohno Naoaki
Department of Brachytherapy for Prostate Cancer.
Department of Urology.
J Contemp Brachytherapy. 2017 Feb;9(1):1-6. doi: 10.5114/jcb.2017.66072. Epub 2017 Feb 20.
To evaluate the outcomes of high-risk prostate cancer patients treated with biologically effective dose (BED) ≥ 220 Gy of high-dose radiotherapy, using low-dose-rate (LDR) brachytherapy in combination with external beam radiotherapy (EBRT) and short-term androgen deprivation therapy (ADT).
From 2005 to 2013, a total of 143 patients with high-risk prostate cancer were treated by radiotherapy of BED ≥ 220 Gy with a combination of LDR brachytherapy, EBRT, and androgen deprivation therapy (ADT). The high-risk patients in the present study included both high-risk and very high-risk prostate cancer. The number of high-risk features were: 60 patients with 1 high-risk factor (42%), 61 patients with 2 high-risk factors (43%), and 22 patients with 3 high-risk factors (15%) including five N1 disease. External beam radiotherapy fields included prostate and seminal vesicles only or whole pelvis depending on the extension of the disease. Biochemical failure was defined by the Phoenix definition.
Six patients developed biochemical failure, thus providing a 5-year actual biochemical failure-free survival (BFFS) rate of 95.2%. Biochemical failure was observed exclusively in cases with distant metastasis in the present study. All six patients with biochemical relapse had clinical failure due to bone metastasis, thus yielding a 5-year freedom from clinical failure (FFCF) rate of 93.0%. None of the cases with N1 disease experienced biochemical failure. We observed four deaths, including one death from prostate cancer, therefore yielding a cause-specific survival (CSS) rate of 97.2%, and an overall survival (OS) rate of 95.5%.
High-dose (BED ≥ 220 Gy) radiotherapy by LDR in combination with EBRT has shown an excellent outcome on BFFS in high-risk and very high-risk cancer, although causal relationship between BED and BFFS remain to be explained further.
评估采用低剂量率（LDR）近距离放射治疗联合外照射放疗（EBRT）及短期雄激素剥夺治疗（ADT），给予生物等效剂量（BED）≥220 Gy的高剂量放疗的高危前列腺癌患者的治疗结果。
2005年至2013年，共有143例高危前列腺癌患者接受了BED≥220 Gy的放疗，联合LDR近距离放射治疗、EBRT及雄激素剥夺治疗（ADT）。本研究中的高危患者包括高危和极高危前列腺癌。高危特征数量为：60例有1个高危因素（42%），61例有2个高危因素（43%），22例有3个高危因素（15%），其中包括5例N1期疾病。外照射放疗野仅包括前列腺和精囊或根据疾病范围包括全盆腔。生化失败采用Phoenix定义。
6例患者出现生化失败，因此5年实际无生化失败生存率（BFFS）为95.2%。在本研究中，生化失败仅在有远处转移的病例中观察到。所有6例生化复发患者均因骨转移出现临床失败，因此5年无临床失败生存率（FFCF）为93.0%。N1期疾病患者均未出现生化失败。我们观察到4例死亡，其中1例死于前列腺癌，因此特异性生存率（CSS）为97.2%，总生存率（OS）为95.5%。
LDR高剂量（BED≥220 Gy）放疗联合EBRT在高危和极高危癌症的BFFS方面显示出优异的结果，尽管BED与BFFS之间的因果关系仍有待进一步解释。
