Grado G L, Larson T R, Balch C S, Grado M M, Collins J M, Kriegshauser J S, Swanson G P, Navickis R J, Wilkes M M
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
Int J Radiat Oncol Biol Phys. 1998 Sep 1;42(2):289-98. doi: 10.1016/s0360-3016(98)00209-0.
To evaluate the effectiveness and safety of interactive transperineal brachytherapy under biplane ultrasound and fluoroscopic guidance in patients with localized prostate cancer.
Brachytherapy using 125I or 103Pd radioactive seeds either alone or in combination with adjunctive external beam radiotherapy (XRT) was administered to 490 patients at a single institution. Post-treatment follow-up included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels and documentation of treatment-related symptoms and complications.
Actuarial disease-free survival at 5 yr was 79% (95% CI, 71-85%), and the 5-yr actuarial rate of local control was 98% (95% CI, 94-99%). Post-treatment PSA nadir and pretreatment PSA level were found to be significant predictors of disease-free survival. In patients with a PSA nadir < 0.5 ng/ml, 5-yr disease-free survival was 93% (95% CI, 84-97%), compared with 25% (95% CI, 5-53%) in patients whose PSA nadir was 0.5-1.0 ng/ml and 15% (95% CI, 3-38) in patients with a PSA nadir > 1.0 ng/ml. Brachytherapy was well tolerated with few post-treatment complications.
A broad range of patients with localized prostate cancer can benefit from transperineal brachytherapy with minimal morbidity. A post-treatment PSA nadir below 0.5 ng/ml provides a useful prognostic indicator of favorable long-term outcome.
评估在双平面超声和荧光透视引导下的交互式经会阴近距离放射治疗对局限性前列腺癌患者的有效性和安全性。
在单一机构对490例患者进行了使用¹²⁵I或¹⁰³Pd放射性粒子的近距离放射治疗，可单独使用或与辅助外照射放疗（XRT）联合使用。治疗后的随访包括疾病状态的临床评估、血清前列腺特异性抗原（PSA）水平测定以及治疗相关症状和并发症的记录。
5年的精算无病生存率为79%（95%CI，71-85%），5年的精算局部控制率为98%（95%CI，94-99%）。发现治疗后PSA最低点和治疗前PSA水平是无病生存的重要预测因素。PSA最低点<0.5 ng/ml的患者，5年无病生存率为93%（95%CI，84-97%），而PSA最低点为0.5-1.0 ng/ml的患者为25%（95%CI，5-53%），PSA最低点>1.0 ng/ml的患者为15%（95%CI，3-38）。近距离放射治疗耐受性良好，治疗后并发症较少。
广泛的局限性前列腺癌患者可从经会阴近距离放射治疗中获益，且发病率极低。治疗后PSA最低点低于0.5 ng/ml是长期预后良好的有用预测指标。
