Critz F A, Levinson A K, Williams W H, Holladay C T, Griffin V D, Holladay D A
Radiotherapy Clinics of Georgia, Decatur, USA.
Cancer J Sci Am. 1998 Nov-Dec;4(6):359-63.
Using a rigorous prostate-specific antigen definition of disease-freedom, the 10-year disease-free survival rates after simultaneous radiation of prostate cancer are presented.
From January 1984 through December 1996, 1020 men with clinical stage T1T2N0 prostate cancer were treated by simultaneous radiation: radioactive 125I prostate implantation followed by external-beam radiation. The median pretreatment prostate-specific antigen was 7.5 ng/mL (range, 0.2-188 ng/mL). Implantation was performed by both the retropubic and the transperineal technique, always followed by external-beam radiation. None received hormone treatment. Disease freedom is defined as achieving and maintaining a posttreatment prostate-specific antigen of < or = 0.5 ng/mL. The median follow-up is 3 years (range, 1-14 years).
The overall 5- and 10-year disease-free survival rates are 79% and 72%, respectively, after which a plateau is reached. At 5 years posttreatment, significantly better disease-free survival results are documented with simultaneous radiation by the ultrasound technique (92%) compared with the retropubic implant technique (73%). On multivariate analysis, pretreatment prostate-specific antigen is the most significant factor associated with disease-free survival, followed by implant technique.
The 10-year disease-free survival rate after simultaneous radiation is comparable to the 10-year results after radical prostatectomy. Disease freedom is defined by the same prostate-specific antigen criteria used for surgery. A plateau in the disease-free curve suggests cure. Of equal importance, the information described in this report should form only a baseline relative to future results as men treated with simultaneous radiation using the transperineal implant technique reach longer follow-up.
采用严格的前列腺特异性抗原无病定义，呈现前列腺癌同步放疗后的10年无病生存率。
1984年1月至1996年12月，1020例临床分期为T1T2N0的前列腺癌男性患者接受了同步放疗：放射性125I前列腺植入术，随后进行外照射。治疗前前列腺特异性抗原的中位数为7.5 ng/mL（范围为0.2 - 188 ng/mL）。植入术采用耻骨后和经会阴技术，之后均进行外照射。无一例接受激素治疗。无病定义为治疗后前列腺特异性抗原达到并维持在≤0.5 ng/mL。中位随访时间为3年（范围为1 - 14年）。
总体5年和10年无病生存率分别为79%和72%，之后达到平台期。治疗后5年，超声技术同步放疗的无病生存结果（92%）显著优于耻骨后植入技术（73%）。多因素分析显示，治疗前前列腺特异性抗原是与无病生存相关的最显著因素，其次是植入技术。
同步放疗后的10年无病生存率与根治性前列腺切除术后的10年结果相当。无病定义采用与手术相同的前列腺特异性抗原标准。无病曲线的平台期提示治愈。同样重要的是，随着经会阴植入技术同步放疗患者随访时间延长，本报告所述信息仅应作为未来结果的基线。
