Slevin Finbar, Hodgson Samantha, Rodda Sree Lakshmi, Bownes Peter, Bottomley David, Adiotomre Ese, Al-Qaisieh Bashar, Dugdale Emma, Hulson Oliver, Mason Joshua, Smith Jonathan, Henry Ann M
Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK.
University of Leeds, Leeds LS2 9JT, UK.
Clin Transl Radiat Oncol. 2020 Mar 27;23:20-26. doi: 10.1016/j.ctro.2020.03.010. eCollection 2020 Jul.
Isolated local recurrence of prostate cancer following primary radiotherapy or brachytherapy may be treated with focal salvage high dose rate brachytherapy, although there remains an absence of high quality evidence to support this approach.
Men with prostate cancer treated consecutively between 2015 and 2018 using 19 Gy in a single fraction high dose rate brachytherapy (HDR) for locally recurrent prostate cancer were identified from an institutional database. Univariable analysis was performed to evaluate the relationship between patient, disease and treatment factors with biochemical progression free survival (bPFS).
43 patients were eligible for evaluation. Median follow up duration was 26 months (range 1-60). Median bPFS was 35 months (95% confidence interval 25.6-44.4). Kaplan-Meier estimates for bPFS at 1, 2 and 3 years post salvage were 95.2%, 70.6% and 41.8% respectively. On univariable Cox regression analysis, only nadir PSA was significantly associated with bPFS although the majority of patients were also treated with androgen deprivation therapy. Only one late grade 3 genitourinary toxicity was observed.
Focal salvage HDR brachytherapy may provide good biochemical control with a low risk of severe toxicity. Further evaluation within clinical trials are needed to establish its role in the management of locally recurrent prostate cancer.
原发性放疗或近距离放射治疗后孤立性前列腺癌局部复发，可采用聚焦挽救性高剂量率近距离放射治疗，尽管仍缺乏高质量证据支持这一方法。
从机构数据库中识别出2015年至2018年间连续接受单次分割19 Gy高剂量率近距离放射治疗（HDR）治疗局部复发性前列腺癌的男性患者。进行单因素分析以评估患者、疾病和治疗因素与无生化进展生存期（bPFS）之间的关系。
43例患者符合评估条件。中位随访时间为26个月（范围1 - 60个月）。中位bPFS为35个月（95%置信区间25.6 - 44.4）。挽救治疗后1年、2年和3年的bPFS的Kaplan-Meier估计值分别为95.2%、70.6%和41.8%。在单因素Cox回归分析中，尽管大多数患者也接受了雄激素剥夺治疗，但只有最低点PSA与bPFS显著相关。仅观察到1例晚期3级泌尿生殖系统毒性反应。
聚焦挽救性HDR近距离放射治疗可能提供良好的生化控制，且严重毒性风险较低。需要在临床试验中进一步评估其在局部复发性前列腺癌管理中的作用。
