How long is long enough to secure disease control after low-dose-rate brachytherapy in combination with other modalities in intermediate-risk, localized prostate cancer?
How long is long enough to secure disease control after low-dose-rate brachytherapy in combination with other modalities in intermediate-risk, localized prostate cancer?
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对于中危、局限性前列腺癌，低剂量率近距离放射治疗与其他治疗方式相结合后，需要多长时间才能确保疾病得到控制？
DOI：
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发表时间：
2021
影响因子：
3.3
通讯作者：
S. Egawa
中科院分区：
文献类型：
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作者：
Fumihiko Urabe;T. Kimura;H. Sasaki;K. Tashiro;K. Iwatani;K. Yasue;M. Aoki;S. Sato;Hiroyuki Takahashi;K. Miki;S. Egawa
先前的研究表明，在中度危险的局限性前列腺癌（PCa）中，接受低剂量率近距离放疗（LDR-BT）的患者总体预后良好。因此，我们研究了治疗后完成前列腺特异性抗原（PSA）监测的适当时间长度。2003年至2014年间，710例局部、中危性PCa患者接受了LDR-BT伴或不伴外束放疗（EBRT）。这项研究分析了其中567名患者的数据。根据一项前瞻性随机对照试验（SHIP0804）的方案，315例患者（55.6%）接受新辅助激素治疗（NHT）， 59例患者（10.4%）接受新辅助激素治疗（AHT）。我们根据治疗后特定时间的PSA水平对患者进行分层，并评估与生化复发（BCR）和临床进展（CP）相关的因素。结果中位随访时间为109个月（范围60 ~ 205个月）。在529例治疗3年后无BCR的患者中，56例随后发展为BCR， 47例发展为CP。治疗后3年和5年的PSA与长期肿瘤预后显著相关。结论如果LDR-BT后5年PSA水平仍≤0.1 ng/mL，无论是单独治疗还是联合治疗，均可作为一种合理的选择，停止PSA监测是中等风险PCa患者的一种合理选择，因为随后的复发非常罕见。
Purpose Previous studies have demonstrated excellent overall outcomes in patients who underwent low-dose-rate brachytherapy (LDR-BT) in intermediate-risk, localized prostate cancer (PCa). We thus investigated the appropriate length of time before completing prostate-specific antigen (PSA) monitoring after treatment. Patients and Methods Between 2003 and 2014, 710 localized, intermediate-risk PCa patients underwent LDR-BT with or without supplemental external beam radiotherapy (EBRT). Data from 567 of those patients was analyzed in this study. Neoadjuvant hormonal therapy (NHT) was administered to 315 patients (55.6 %) and NHT with adjuvant hormonal therapy (AHT) to 59 patients (10.4 %), as per the protocol of a prospective randomized controlled trial (SHIP0804). We stratified patients by posttreatment PSA levels at specific times and assessed the factors for association with biochemical recurrence (BCR) and for clinical progression (CP). Results The median follow-up was 109 months (range, 60-205 months). Of 529 patients who were BCR-free at 3 years after treatment, 56 subsequently developed BCR, and 47 developed CP. PSA at 3 and 5 years after treatment were significantly correlated with long-term oncological outcomes. No patients with 5-year PSA levels ≤0.1 ng/mL subsequently developed BCR or CP. Conclusion Discontinuation of PSA monitoring could be discussed with patients with intermediate-risk PCa as a reasonable option if PSA levels remain ≤0.1 ng/mL at 5 years after LDR-BT, either alone or with other combined modalities, as subsequent recurrences are quite rare.
影响因子：
2.1
作者：
Skove SL;Howard LE;Aronson WJ;Terris MK;Kane CJ;Amling CL;Cooperberg MR;Moreira DM;Freedland SJ
通讯作者：
Freedland SJ