Okamoto Keisei, Okuyama Kahori, Kohno Naoaki, Tsugawa Takuya
Department of Brachytherapy for Prostate Cancer, Shiga University of Medical Science, Shiga, Japan.
Department of Radiology, Shiga University of Medical Science, Shiga, Japan.
J Contemp Brachytherapy. 2020 Feb;12(1):6-11. doi: 10.5114/jcb.2020.92405. Epub 2020 Feb 28.
To monitor the outcomes for intermediate-risk prostate cancer patients treated with biologically effective dose (BED) ≥ 200 Gy radiotherapy using low-dose-rate (LDR) brachytherapy.
Between 2005 and 2016, a total of 397 patients with intermediate-risk prostate cancer were treated by LDR-based radiotherapy with a BED ≥ 200 Gy. Treatments consisted of LDR brachytherapy alone (177 cases) or LDR and external beam radiotherapy (EBRT) (220 cases). Short-term androgen deprivation therapy (ADT) was used in 186 patients (46.9%). The median follow-up period was 72 months (range 29-165 months). Dosimetric parameters and BED were studied in each case. The numbers of intermediate-risk features were: 163 patients with 1 intermediate-risk feature (41%), 169 patients with 2 intermediate-risk features (43%), and 65 patients with 3 intermediate-risk features (16%). A total of 145 cases were diagnosed as having primary Gleason pattern 4: Gleason score 4 + 3 (36.5%).
Three patients developed biochemical failure, thus providing a 7-year actual biochemical failure-free survival (BFFS) rate of 99.1%. Biochemical failure was observed exclusively in cases with distant metastasis: two cases with lymph node metastasis and one case with bone metastasis, thus yielding a 7-year freedom from clinical failure (FFCF) rate of 99.1%. We observed eight deaths, but there was no death from prostate cancer, thus yielding a 7-year cause-specific survival (CSS) rate of 100%, and an overall survival (OS) rate of 98.4%.
This study highlights excellent outcomes for intermediate-risk prostate cancer patients, including unfavorable intermediate-risk cases, treated with BED ≥ 200 Gy radiotherapy using LDR brachytherapy. LDR alone with a BED of 200 Gy may be an optimal treatment for both favorable and unfavorable intermediate-risk prostate cancer patients, although a longer follow-up is mandatory to confirm the present findings.
监测采用低剂量率（LDR）近距离放射治疗、生物等效剂量（BED）≥200 Gy的中危前列腺癌患者的治疗结果。
2005年至2016年期间，共有397例中危前列腺癌患者接受了基于LDR的放射治疗，BED≥200 Gy。治疗包括单纯LDR近距离放射治疗（177例）或LDR与外照射放疗（EBRT）联合治疗（220例）。186例患者（46.9%）采用了短期雄激素剥夺治疗（ADT）。中位随访期为72个月（范围29 - 165个月）。对每例患者的剂量学参数和BED进行了研究。中危特征的数量为：163例患者有1个中危特征（41%），169例患者有2个中危特征（43%），65例患者有3个中危特征（16%）。共有145例被诊断为主要 Gleason 模式4：Gleason评分4 + 3（36.5%）。
3例患者出现生化失败，因此7年实际无生化失败生存率（BFFS）为99.1%。生化失败仅在远处转移的病例中观察到：2例有淋巴结转移，1例有骨转移，因此7年无临床失败生存率（FFCF）为99.1%。我们观察到8例死亡，但没有死于前列腺癌的病例，因此7年特定病因生存率（CSS）为100%，总生存率（OS）为98.4%。
本研究突出了采用LDR近距离放射治疗、BED≥200 Gy放疗的中危前列腺癌患者，包括预后不良的中危病例，取得了优异的治疗结果。对于预后良好和不良的中危前列腺癌患者，单纯BED为200 Gy的LDR可能是一种最佳治疗方法，尽管需要更长时间的随访来证实目前的研究结果。
