Results of permanent prostate brachytherapy, 13 years of experience at a single institution
Results of permanent prostate brachytherapy, 13 years of experience at a single institution
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DOI：
10.1016/j.radonc.2004.01.020
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发表时间：
2004-04-01
影响因子：
5.7
通讯作者：
Moerland, MA
中科院分区：
文献类型：
--
作者：
Battermann, JJ;Boon, TA;Moerland, MA
背景和目的：为了了解治疗技术对最终结果的影响，以及风险组和 PSA 最低点对结果的关系，我们回顾了 10 多年的经验。患者和方法：患者在 1989 年至 2000 年期间接受治疗。可用于本次评估的患者有 351 名。按 T 分期划分的病例分布为 T I a、b (9%)、Tlc (49%)、T2 (42%)，按分级划分为 G1 (58%)、G2 (38%)、G3 (1%) 和 Gx (3%)。多年来，种子种植技术各不相同，首先是使用 Mick 施药器（104 名患者）单粒种子，然后是不带种子的快速播种（70 名患者）和预先计划的种子（177 名患者）。风险组被分类为低风险组（iPSA < 10 ng/ml，Tl-2，1 级），116 名患者；中级（iPSA 10-20 ng/ml，或 2-3 级），114 名患者；和高风险（两个因素，或 iPSA > 20 ng/ml），121 名患者。平均随访时间为 50 个月。中位数为 48 个月，范围为 24-123 个月。结果：5 年和 7 年的总体精算生存率分别为 85% 和 76%。四十名患者死亡，其中八名 (2%) 因前列腺癌或患有前列腺癌。存活的患者有 310 名（88%），其中 223 名患者患有 NED（71%），51 名患者（16%）患有 PSA 失败，21 名患者（7%）患有局部复发，15 名患者（5%）患有远处复发。总 bNED 为 72%。尽管自引入快速链以来结果更好，单种子的 bNED 为 79%，bNED 为 54% (P = 0. 14)，但每 cm(3) 前列腺体积的活性增加也是这种改善的原因。与未经规划的单粒种子或线束相比，通过预先规划可获得显着更好的结果 (P < 0.03)。按风险组分类，bNED 与危险因素存在显着差异（P < 0.007），分别为高风险组 57%，中风险组 75%，低风险组 89%。 PSA 最低点对结果也有显着影响。达到低于或等于 0.5 ng/ml 最低值的患者有 91% 的治愈机会。 结论：随着股线的引入，永久粒子植入的结果得到改善，然而，更好的分期和每 cm I 前列腺体积活性的增加也促成了这种改善。通过预先规划获得了明显更好的结果。风险组的分类与治疗结果非常吻合。最后，发现与 PSA 最低点有很强的关系。 (C) 2004 Elsevier Ireland Ltd. 保留所有权利。
Background and purpose: To understand the influence of treatment techniques on the final outcome, as well as the relation of risk groups and of PSA nadir on the outcome, we reviewed our experience over more than 10 years. Patients and methods: Patients were treated in the period 1989 through 2000. Available for this evaluation are 351 patients. The distribution of cases by T stage was T I a, b (9%), Tlc (49%), T2 (42%), and by grading G1 (58%), G2 (38%), G3 (1%) and Gx (3%). The technique of plantation of seeds varied over the years, starting with single seeds using a Mick applicator (104 patients), followed by Rapid strands without (70) and with pre-planning (177). Risk groups are categorised as low (iPSA < 10 ng/ml, Tl-2, grade 1), 116 patients; intermediate (iPSA 10-20 ng/ml, or grade 2-3), 114 patients; and high risk (both factors, or iPSA > 20 ng/ml), 121 patients. The mean follow-up time was 50 months. median 48 and range 24-123 months.Results: Overall actuarial survival at 5 and 7 years was 85 and 76%, respectively. Forty patients died, eight (2%) because of or with prostate cancer. Alive are 310 patients (88%), with 223 patients bNED (71%), 51 (16%) with PSA failure, 21 (7%) with local and 15 (5%) with distant recurrence. Total bNED was 72%. Although results are better since the introduction of Rapid strands, 79% bNED versus 54% bNED for single seeds (P = 0. 14), also the increase in activity per cm(3) prostate volume accounts for this improvement. With pre-planning a significant better result (P < 0.03) is obtained as compared to single seeds or strands without planning. Categorisation into risk groups results in a significant difference (P < 0.007) of bNED with risk factors, respectively, 57% for the high, 75% for the intermediate and 89% for the low risk group. Also PSA nadir had a significant effect on outcome; patients who reach a nadir of less than or equal to 0.5 ng/ml have a 91 % chance of cure.Conclusions: Results of permanent seed implantation improved with the introduction of strands, however, better staging and the increase in activity per cm I prostate volume also contributed to this improvement. A significant better result was obtained with pre-planning. Categorisation in risk groups corresponds very well with treatment outcome. Finally, a strong relation is found with PSA nadir. (C) 2004 Elsevier Ireland Ltd. All rights reserved.