Departments of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
The Brachytherapy Center, Hygeia Hospital, Athens, Greece.
Brachytherapy. 2020 Sep-Oct;19(5):567-573. doi: 10.1016/j.brachy.2020.06.001. Epub 2020 Aug 3.
Brachytherapy boost improves biochemical recurrence rates in men with high-risk prostate cancer (HRPC). Few data are available on whether one isotope is superior to another. We compared the oncologic and morbidity outcomes of I-125 and Pd-103 in men with HRPC receiving brachytherapy.
Of 797 patients with HRPC, 190 (23.8%) received I-125 or 607 received Pd-103 with a median of 45 Gy of external beam irradiation. Freedom from biochemical failure (FFBF), freedom from metastases (FFMs), cause-specific survival (CSS), and morbidity were compared for the two isotopes by the ANOVA and the χ test with survival determined by the Kaplan-Meier method and Cox regression.
Men treated with I-125 had a higher stage (p < 0.001), biological equivalent dose (BED) (p < 0.001), and longer hormone therapy (neoadjuvant hormone therapy, p < 0.001), where men treated with Pd-103 had a higher Gleason score (GS, p < 0.001) and longer followup (median 8.3 vs. 5.3 years, p < 0.001). Ten-year FFBF, FFM, and CSS for I-125 vs. Pd-103 were 77.5 vs. 80.2% (p = 0.897), 94.7 vs. 91.9% (p = 0.017), and 95.4 vs. 91.8% (p = 0.346), respectively. Men with T3 had superior CSS (94.1 vs. 79.5%, p = 0.001) with I-125. Significant covariates by Cox regression for FFBF were prostate specific antigen (PSA), the GS, and the BED (p < 0.001), for FFM PSA (p < 0.001) and GS (p = 0.029), and for CSS PSA, the GS (p < 0.001) and the BED (p = 0.022). Prostate cancer mortality was 7/62 (15.6%) for BED ≤ 150 Gy, 18/229 (7.9%) for BED >150-200 Gy, and 20/470 (5.9%) for BED >200 Gy (p = 0.029). Long-term morbidity was not different for the two isotopes.
Brachytherapy boost with I-125 and Pd-103 appears equally effective yielding 10-year CSS of over 90%. I-125 may have an advantage in T3 disease. Higher doses yield the most favorable survival.
近距离放射治疗加量可提高高危前列腺癌（HRPC）患者的生化复发率。目前有关哪种同位素更优的数据很少。我们比较了 HRPC 患者接受近距离放射治疗时使用碘-125 和钯-103 的肿瘤学和发病率结果。
在 797 例 HRPC 患者中，190 例（23.8%）接受碘-125 治疗，607 例接受钯-103 治疗，中位外照射剂量为 45Gy。通过 ANOVA 和 χ 检验比较两种同位素的生化无失败率（FFBF）、无转移率（FFMs）、特异性生存率（CSS）和发病率，生存由 Kaplan-Meier 方法和 Cox 回归确定。
接受碘-125 治疗的患者分期更高（p < 0.001），生物等效剂量（BED）更高（p < 0.001），激素治疗时间更长（新辅助激素治疗，p < 0.001），而接受钯-103 治疗的患者 Gleason 评分更高（GS，p < 0.001），随访时间更长（中位数 8.3 比 5.3 年，p < 0.001）。碘-125 与钯-103 的 10 年 FFBF、FFM 和 CSS 分别为 77.5%比 80.2%（p=0.897）、94.7%比 91.9%（p=0.017）和 95.4%比 91.8%（p=0.346）。接受碘-125 治疗的 T3 患者 CSS 更高（94.1%比 79.5%，p=0.001）。Cox 回归分析的显著协变量为 PSA、GS 和 BED（p<0.001）、FFM PSA（p<0.001）和 GS（p=0.029）、CSS PSA、GS（p<0.001）和 BED（p=0.022）。BED≤150Gy 的前列腺癌死亡率为 7/62（15.6%），BED>150-200Gy 的为 18/229（7.9%），BED>200Gy 的为 20/470（5.9%）（p=0.029）。两种同位素的长期发病率无差异。
碘-125 和钯-103 近距离放射治疗加量似乎同样有效，10 年 CSS 超过 90%。碘-125 可能在 T3 疾病中有优势。较高的剂量可获得最佳的生存结果。
