Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update
Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update
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DOI：
10.1200/jco.2016.72.0466
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发表时间：
2017-05-20
影响因子：
45.3
通讯作者：
Loblaw, D. Andrew
中科院分区：
文献类型：
--
作者：
Chin, Joseph;Rumble, R. Bryan;Loblaw, D. Andrew
目的联合更新安大略省癌症护理指南关于前列腺癌患者近距离放疗的新证据。方法更新小组进行了一项有针对性的系统文献综述，并确定了最近比较剂量递增的外束放射治疗（EBRT）和近距离治疗前列腺癌男性的随机对照试验。结果五项随机对照试验为这一更新提供了证据。对于需要或选择积极治疗的低风险前列腺癌患者，应向符合条件的患者提供单独的低剂量率近距离放疗（LDR），单独的EBRT和/或根治性前列腺切除术（RP）。对于选择EBRT联合或不联合雄激素剥夺治疗的中危前列腺癌患者，应向符合条件的患者提供近距离增强治疗（LDR或高剂量率[HDR]）。对于低、中危前列腺癌（Gleason 7，前列腺特异性抗原< 10 ng/mL或Gleason 6，前列腺特异性抗原，10 ~ 20 ng/mL），可单独LDR近距离放疗作为单药治疗。对于接受EBRT和雄激素剥夺治疗的高危前列腺癌患者，应向符合条件的患者提供近距离治疗增强（LDR或HDR）。碘-125和钯-103都是接受LDR近距离放疗的患者的合理同位素选择；没有建议支持或反对使用铯-131或HDR单一疗法。应鼓励患者参与临床试验，以测试治疗这种疾病的新方法或靶向方法。更多信息请访问www.asco.org/Brachytherapy-guideline和www.asco.org/guidelineswiki。
PurposeTo jointly update the Cancer Care Ontario guideline on brachytherapy for patients with prostate cancer to account for new evidence.MethodsAn Update Panel conducted a targeted systematic literature review and identified more recent randomized controlled trials comparing dose-escalated external beam radiation therapy (EBRT) with brachytherapy in men with prostate cancer.ResultsFive randomized controlled trials provided the evidence for this update.RecommendationsFor patients with low-risk prostate cancer who require or choose active treatment, low-dose rate brachytherapy (LDR) alone, EBRT alone, and/or radical prostatectomy (RP) should be offered to eligible patients. For patients with intermediate-risk prostate cancer choosing EBRT with or without androgen-deprivation therapy, brachytherapy boost (LDR or high-dose rate [HDR]) should be offered to eligible patients. For low-intermediate risk prostate cancer (Gleason 7, prostate-specific antigen < 10 ng/mL or Gleason 6, prostate-specific antigen, 10 to 20 ng/mL), LDR brachytherapy alone may be offered as monotherapy. For patients with high-risk prostate cancer receiving EBRT and androgen-deprivation therapy, brachytherapy boost (LDR or HDR) should be offered to eligible patients. Iodine-125 and palladium-103 are each reasonable isotope options for patients receiving LDR brachytherapy; no recommendation can be made for or against using cesium-131 or HDR monotherapy. Patients should be encouraged to participate in clinical trials to test novel or targeted approaches to this disease.Additional information is available at www.asco.org/Brachytherapy-guideline and www.asco.org/guidelineswiki.