Kaye K W, Olson D J, Payne J T
Department of Urology, Abbott Northwestern Hospital, Minneapolis, Minnesota.
J Urol. 1995 Mar;153(3 Pt 2):1020-5.
Recent developments have permitted accurate seed placement and dosimetry for interstitial brachytherapy of selected patients with localized prostate cancer. We present our experience with 76 patients divided into 2 groups. Group 1 included 45 patients with smaller, more well differentiated tumors, usually less than 2 cm. in diameter on digital rectal examination or transrectal ultrasound and a Gleason score of less than 7 who were treated with 125iodine alone. Group 2 consisted of 31 patients with localized tumors greater than 2 cm. in diameter and/or a Gleason sum equal to or greater than 7 who were treated with low dose external beam radiation followed by 125iodine boost 4 weeks later. Complete clinical progression-free survival, including prostate specific antigen, digital rectal examination and biopsy, was 51% for group 1 and 63.3% for group 2, with a mean followup of 26.3 months. Prostate specific antigen progression-free survival was 97.7% for group 1 and 94.7% for group 2. These results appear to be superior to external beam radiation only although longer followup is needed to substantiate these favorable early results. The procedures were well tolerated with good potency sparing. They were performed on an outpatient or short stay basis and provided a good alternative to external beam radiation only or hormonal treatment for select patients with localized prostate cancer who may not be candidates for radical prostatectomy.
近年来的进展已使得对某些局限性前列腺癌患者进行组织间近距离治疗时能够精确地植入籽源并进行剂量测定。我们介绍了对76例患者的治疗经验，这些患者被分为两组。第1组包括45例患者，其肿瘤较小且分化较好，在直肠指检或经直肠超声检查中直径通常小于2厘米，Gleason评分小于7，仅接受¹²⁵碘治疗。第2组由31例患者组成，其局限性肿瘤直径大于2厘米和/或Gleason总分等于或大于7，先接受低剂量外照射，4周后再接受¹²⁵碘补充照射。第1组的完全临床无进展生存率（包括前列腺特异性抗原、直肠指检和活检）为51%，第2组为63.3%，平均随访26.3个月。第1组的前列腺特异性抗原无进展生存率为97.7%，第2组为94.7%。尽管需要更长时间的随访来证实这些良好的早期结果，但这些结果似乎优于单纯外照射。这些操作耐受性良好，能很好地保留性功能。它们在门诊或短期住院的基础上进行，为那些可能不适合行根治性前列腺切除术的局限性前列腺癌患者提供了一种优于单纯外照射或激素治疗的良好选择。
