Joseph Chin, London Health Sciences Centre, London; Andrew Feifer, Trillium Health Partners' Fidani Cancer Centre, University Health Network, Mississauga; Arthur Jacques, Patient Representative; D. Andrew Loblaw, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Marisa Kollmeier, Memorial Sloan Kettering Cancer Center, New York, NY; Elisabeth Heath, Karmanos Cancer Institute, Detroit, MI; Jason Efstathiou, Massachusetts General Hospital, Boston, MA; Tanya Dorff, USC Norris Cancer Center, Los Angeles, CA; and Barry Berman, Broward Health, Fort Lauderdale, FL.
J Clin Oncol. 2017 May 20;35(15):1737-1743. doi: 10.1200/JCO.2016.72.0466. Epub 2017 Mar 27.
Purpose To jointly update the Cancer Care Ontario guideline on brachytherapy for patients with prostate cancer to account for new evidence. Methods An Update Panel conducted a targeted systematic literature review and identified more recent randomized controlled trials comparing dose-escalated external beam radiation therapy (EBRT) with brachytherapy in men with prostate cancer. Results Five randomized controlled trials provided the evidence for this update. Recommendations For patients with low-risk prostate cancer who require or choose active treatment, low-dose rate brachytherapy (LDR) alone, EBRT alone, and/or radical prostatectomy (RP) should be offered to eligible patients. For patients with intermediate-risk prostate cancer choosing EBRT with or without androgen-deprivation therapy, brachytherapy boost (LDR or high-dose rate [HDR]) should be offered to eligible patients. For low-intermediate risk prostate cancer (Gleason 7, prostate-specific antigen < 10 ng/mL or Gleason 6, prostate-specific antigen, 10 to 20 ng/mL), LDR brachytherapy alone may be offered as monotherapy. For patients with high-risk prostate cancer receiving EBRT and androgen-deprivation therapy, brachytherapy boost (LDR or HDR) should be offered to eligible patients. Iodine-125 and palladium-103 are each reasonable isotope options for patients receiving LDR brachytherapy; no recommendation can be made for or against using cesium-131 or HDR monotherapy. Patients should be encouraged to participate in clinical trials to test novel or targeted approaches to this disease. Additional information is available at www.asco.org/Brachytherapy-guideline and www.asco.org/guidelineswiki .
更新安大略省癌症护理学会关于前列腺癌近距离放射治疗的指南，纳入新证据。
更新小组进行了有针对性的系统文献回顾，并确定了更多比较前列腺癌男性中剂量递增外照射放射治疗（EBRT）与近距离放射治疗的随机对照试验。
五项随机对照试验为本次更新提供了证据。
对于需要或选择积极治疗的低危前列腺癌患者，应向符合条件的患者提供单纯低剂量率近距离放射治疗（LDR）、EBRT 单独治疗和/或根治性前列腺切除术（RP）。对于选择 EBRT 联合或不联合雄激素剥夺治疗的中危前列腺癌患者，应向符合条件的患者提供近距离放射治疗（LDR 或高剂量率[HDR]）加量。对于低中危前列腺癌（Gleason 7，前列腺特异性抗原<10ng/mL 或 Gleason 6，前列腺特异性抗原，10-20ng/mL），可单独使用 LDR 近距离放射治疗作为单一疗法。对于接受 EBRT 和雄激素剥夺治疗的高危前列腺癌患者，应向符合条件的患者提供近距离放射治疗（LDR 或 HDR）加量。对于接受 LDR 近距离放射治疗的患者，碘 125 和钯 103 都是合理的同位素选择；对于使用铯 131 或 HDR 单一疗法，无法做出推荐或反对的意见。应鼓励患者参与临床试验，以测试针对这种疾病的新的或靶向方法。更多信息可在 www.asco.org/Brachytherapy-guideline 和 www.asco.org/guidelineswiki 上获取。
