Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
BJU Int. 2018 May;121(5):774-780. doi: 10.1111/bju.14128. Epub 2018 Feb 16.
To evaluate the cancer control outcomes and long-term treatment-related morbidity of brachytherapy as well as combination brachytherapy and external beam radiation therapy (EBRT) in patients with intermediate-risk prostate cancer.
A retrospective review was conducted in a prospectively collected database of patients with intermediate-risk prostate cancer who were treated either with brachytherapy or brachytherapy and EBRT, with or without androgen deprivation therapy (ADT), in the period 1990-2014. Urinary and erectile dysfunction symptoms were measured using the International Prostate Symptom Score (IPSS), the Mount Sinai erectile function scale and the Sexual Health Inventory for Men (SHIM). Cancer control endpoints included biochemical failure and development of distant metastases. All statistical analyses were carried out using the Statistical Package for Social Science (SPSS). Survival curves were calculated using Kaplan-Meier actuarial methods and compared using log-rank tests. Cox regression multivariate analyses were used to test the effect of multiple variables on treatment outcomes.
A total of 902 patients were identified, with a median follow-up of 91 months. Of these, 390 received brachytherapy and 512 received combination therapy with EBRT. In patients with one intermediate-risk factor, the addition of EBRT did not significantly affect freedom from biochemical failure or distant metastases. Among patients with two or three intermediate-risk factors, added EBRT did not improve freedom from biochemical failure. Significant differences in late toxicity between patients treated with brachytherapy vs combination brachytherapy and EBRT were identified including urge incontinence (P < 0.001), haematuria (P < 0.001), dysuria (P < 0.001), and change in quality-of-life IPSS (P = 0.002). These symptoms were reported by patients at any point during treatment follow-up. Analysis of patients who were potent before treatment using actuarial methods showed that patients receiving combination therapy more frequently experienced loss of potency, as measured by the Mount Sinai erectile function scale (P = 0.040).
Brachytherapy monotherapy results in equal biochemical and distant control in both patients with one and more than one intermediate-risk features. While no significant benefit was shown, we believe that the addition of EBRT may prevent recurrence in patients with multiple intermediate-risk features and should be considered.
评估近距离放射治疗以及近距离放射治疗联合外束放射治疗（EBRT）在中危前列腺癌患者中的癌症控制结果和长期治疗相关的发病率。
对 1990 年至 2014 年期间接受近距离放射治疗或近距离放射治疗联合 EBRT 治疗（联合或不联合雄激素剥夺治疗（ADT））的中危前列腺癌患者的前瞻性数据库进行回顾性研究。使用国际前列腺症状评分（IPSS）、蒙特利尔勃起功能量表和男性性功能健康量表（SHIM）来评估尿失禁和勃起功能障碍症状。癌症控制终点包括生化失败和远处转移的发展。所有统计分析均使用社会科学统计软件包（SPSS）进行。生存曲线通过 Kaplan-Meier 生存分析方法计算，并通过对数秩检验进行比较。Cox 回归多变量分析用于测试多个变量对治疗结果的影响。
共纳入 902 例患者，中位随访时间为 91 个月。其中 390 例患者接受近距离放射治疗，512 例患者接受近距离放射治疗联合 EBRT 治疗。在仅有一个中危因素的患者中，联合 EBRT 治疗并未显著影响生化无失败率或远处转移率。在具有两个或三个中危因素的患者中，联合 EBRT 治疗并未改善生化无失败率。接受近距离放射治疗与近距离放射治疗联合 EBRT 治疗的患者之间在晚期毒性方面存在显著差异，包括急迫性尿失禁（P<0.001）、血尿（P<0.001）、排尿困难（P<0.001）和生活质量 IPSS 评分的变化（P=0.002）。这些症状在治疗随访的任何时候都有患者报告。通过生存分析方法对治疗前有勃起功能的患者进行分析，发现接受联合治疗的患者勃起功能丧失更为常见，表现为蒙特利尔勃起功能量表评分降低（P=0.040）。
近距离放射治疗单药治疗在具有一个或多个中危特征的患者中具有相等的生化和远处控制效果。虽然没有显示出显著的益处，但我们认为联合 EBRT 治疗可能有助于预防具有多个中危特征的患者复发，因此应该考虑使用。
