Salembier Carl, Henry Ann, Pieters Bradley R, Hoskin Peter
Department of Radiotherapy, Europe Hospitals Brussels, Belgium.
University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
J Contemp Brachytherapy. 2020 Feb;12(1):1-5. doi: 10.5114/jcb.2020.92913. Epub 2020 Feb 28.
Early reports suggested that transurethral resection (TURP) prior to permanent seed brachytherapy (BT) results in high incontinence rates. Guidelines consider prior TURP as a contra-indication to treatment, but improvements in imaging and treatment planning may reduce this risk, and are investigated in this prospective study.
99 men with histologically proven low- to intermediate-risk, localized prostate cancer, with a history of TURP performed at least 3 months before BT procedure were enrolled. All patients received a permanent seed implant between March 2009 and June 2015. Intra-operative interactive planning was recommended to ensure optimal accuracy of seed placement during the procedure. No supplemental external beam was allowed. Target and organ at risk contouring, definition of clinical target volume (CTV), and dosimetric parameters followed the modified GEC-ESTRO guidelines for permanent seed implants, as described an earlier report of our group. Follow-up was scheduled every 3 months for the first year, and every 6 months afterwards, with minimum follow-up of 2 years.
The primary endpoint was the incidence of post-implant urinary incontinence. Secondary endpoints were the incidence of urinary and gastro-intestinal toxicity, the eventual impact on the sexual function, and the freedom from biochemical failure.
The median follow-up time for these 99 patients was 49 months (min. 24, max. 96). In this series, the incontinence rate was 2% after TURP + BT and 2% in case of TURP + BT + re-TURP, ending up with a total urinary incontinence rate of 4%. Acute and late urinary toxicities were extremely low. No significant late gastro-intestinal toxicity was seen, and the 5-year biochemical non-evidence of disease (bNED) was 93%.
The excellent long-term results and low morbidity presented as well as many advantages of prostate brachytherapy over other treatments demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and organ-confined prostate cancer.
早期报告表明，在永久性粒子植入近距离放射治疗（BT）之前进行经尿道前列腺切除术（TURP）会导致高尿失禁发生率。指南将既往TURP视为治疗的禁忌证，但成像和治疗计划的改进可能会降低这种风险，本前瞻性研究对此进行了调查。
纳入99例经组织学证实为低至中危、局限性前列腺癌且在BT手术前至少3个月有TURP病史的男性患者。所有患者于2009年3月至2015年6月期间接受永久性粒子植入。建议术中进行交互式计划以确保手术过程中粒子植入的最佳准确性。不允许使用补充外照射。靶区和危及器官的轮廓勾画、临床靶区体积（CTV）的定义以及剂量学参数遵循我们小组早期报告中所述的永久性粒子植入的改良GEC-ESTRO指南。随访计划在第一年每3个月进行一次，之后每6个月进行一次，最短随访2年。
主要终点是植入后尿失禁的发生率。次要终点是泌尿和胃肠道毒性的发生率、对性功能的最终影响以及无生化失败。
这99例患者的中位随访时间为49个月（最短24个月，最长96个月）。在本系列中，TURP + BT术后尿失禁率为2%，TURP + BT +再次TURP术后尿失禁率为2%，最终总尿失禁率为4%。急性和晚期泌尿毒性极低。未观察到明显的晚期胃肠道毒性，5年无生化疾病证据（bNED）为93%。
所呈现的出色长期结果和低发病率以及前列腺近距离放射治疗相对于其他治疗的诸多优势表明，近距离放射治疗是经尿道前列腺切除和器官局限性前列腺癌患者的有效治疗方法。
