Departments of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
The Brachytherapy Center, Hygeia Hospital, Athens, Greece.
Brachytherapy. 2020 May-Jun;19(3):275-281. doi: 10.1016/j.brachy.2020.01.008. Epub 2020 Mar 23.
Men with Gleason grade Group (GG) 4 and 5 prostate cancer have high failure rates when treated by conventional therapy. We investigated the effect of higher radiation doses on freedom from biochemical failure (FBF) and prostate cancer mortality (cause-specific survival [CSS]) in men treated with a combination of permanent implant and external beam irradiation (EBRT).
Three hundred twenty men with GG4 (n = 186) and 5 (n = 134) prostate cancer were treated with I-125 or Pd-103 implant followed by 45 Gy of EBRT. Radiation doses were converted to the biological equivalent dose (BED). The median age, prostate-specific antigen (PSA), time on hormone therapy, BED, and followup were 69 years, 9.0 ng/mL, 9 months, 210 Gy, and 6.5 years, respectively. FBF and CSS were calculated by Kaplan-Meier method with associations determined by log rank and Cox regression.
Ten-year FBF for GG4 vs. 5 was 77.8 vs. 61.3% (p = 0.015), and CSS was 94 vs. 79.3% (p = 0.001). Men with lower PSA had improved FBF and CSS (p < 0.001). Thirty-one of 320 died of prostate cancer of which 10/186 (5.4%) had GG4 and 21/134 (15.7%) GG5 (OR 3.3, p = 0.002). BED <200 Gy was associated with a 2.2× greater BF (p = 0.004) and 2.4× prostate cancer mortality (p = 0.020). Significant covariates on regression analysis for FBF and CSS were PSA (p = 0.014), GG (p = 0.007), BED (p = 0.009), and GG (p = 0.001).
Survival rates for high-grade prostate cancer are favorable when diagnosed in men with lower PSA and treated with doses of BED > 200 Gy. Higher BED is achieved with a combination of I-125 (110 Gy) or Pd-103 (100 Gy) and 45 Gy EBRT.
采用常规疗法治疗格里森分级组（GG）4 和 5 前列腺癌的男性患者，其生化失败（FFB）和前列腺癌死亡率（特异性生存[CSS]）的失败率较高。我们研究了在接受永久性植入物和外部束放射治疗（EBRT）联合治疗的男性中，较高的辐射剂量对 FFB 和前列腺癌死亡率（CSS）的影响。
320 名 GG4（n=186）和 5（n=134）前列腺癌患者接受 I-125 或 Pd-103 植入物治疗，随后接受 45Gy 的 EBRT。辐射剂量转换为生物等效剂量（BED）。中位年龄、前列腺特异性抗原（PSA）、激素治疗时间、BED 和随访分别为 69 岁、9.0ng/mL、9 个月、210Gy 和 6.5 年。FFB 和 CSS 通过 Kaplan-Meier 方法计算，关联通过对数秩和 Cox 回归确定。
GG4 与 GG5 的 10 年 FFB 分别为 77.8%和 61.3%（p=0.015），CSS 分别为 94%和 79.3%（p=0.001）。PSA 较低的男性具有改善的 FFB 和 CSS（p<0.001）。320 名男性中有 31 名死于前列腺癌，其中 10/186（5.4%）为 GG4，21/134（15.7%）为 GG5（OR 3.3，p=0.002）。BED<200Gy 与 BF 增加 2.2 倍（p=0.004）和前列腺癌死亡率增加 2.4 倍（p=0.020）相关。FFB 和 CSS 的回归分析中的显著协变量是 PSA（p=0.014）、GG（p=0.007）、BED（p=0.009）和 GG（p=0.001）。
在 PSA 较低的男性中诊断出高等级前列腺癌并接受 BED>200Gy 的治疗时，生存率良好。通过 I-125（110Gy）或 Pd-103（100Gy）和 45GyEBRT 的联合治疗可以达到更高的 BED。
