Five-year biochemical outcome following permanent interstitial brachytherapy for clinical T1-T3 prostate cancer
Five-year biochemical outcome following permanent interstitial brachytherapy for clinical T1-T3 prostate cancer
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DOI：
10.1016/s0360-3016(01)01594-2
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发表时间：
2001-09-01
影响因子：
7
通讯作者：
Lief, JH
中科院分区：
文献类型：
--
作者：
Merrick, GS;Butler, WM;Lief, JH
目的：评估临床T1 b-T3 a NxM 0男性患者的5年无生化疾病结局1977年美国癌症联合委员会（1997 AJCC）前列腺腺癌，接受经会阴超声引导下永久性前列腺近距离放射治疗。425例患者接受了经会阴超声引导的前列腺近距离放射治疗，使用Pd-103或I-125，临床T1 b-T3 a NxMO（1997 AJCC）前列腺腺癌，从1995年4月至1999年10月。没有患者接受病理淋巴结分期。190名患者植入Pd-103或I-125单药治疗; 235名患者接受中等剂量体外放射治疗（EBRT），随后接受前列腺近距离放射治疗增强; 163例患者接受了新辅助激素操作，联合Pd-103或I-125单药治疗（77例患者）或联合中等剂量EBRT和前列腺近距离放射治疗加强（86例患者）。患者中位年龄为68.0岁（范围：48.2-81.3岁）。中位随访时间为31个月（范围：11-69个月）。从植入当天开始计算随访时间。无患者失访。生化无病生存率由美国放射治疗与肿瘤学会（ASTRO）共识definition.Results：对于整个队列，5年精算生化无疾病证据（bNED）生存率为94%。低危、中危和高危患者的5年生化无病率分别为97.1%、97.5%和84.4%。对于初治患者，95.7%、96.4%和79.9%的低危、中危和高危患者无生化失败。预测生化结果的临床和治疗参数包括：临床分期、治疗前前列腺特异性抗原（PSA）、Gleason评分、风险组、年龄> 65岁和新辅助激素治疗。同位素的选择并不是任何风险组无病生存率的统计学显著预测因素。无论激素状态如何，所有风险组的中位植入后PSA均小于或等于0.2。然而，植入Pd-103的男性的平均治疗后PSA显著较低（0.14 ng/mL），而植入I-125的受试者（0.25 ng/mL），p ≤ 0.001。结论：中位随访时间为31个月，对于临床T1 b-T3 a患者，永久性前列腺近距离放射治疗可获得较高的5年无生化疾病生存率（DFS）概率（1997 AJCC）前列腺腺癌，PSA存活曲线上有明显的平台期。(C)2001 Elsevier Science Inc.
Purpose: To evaluate 5-year biochemical disease-free outcome for men with clinical T1b-T3a NxM0 1977 American Joint Committee on Cancer (1997 AJCC) adenocarcinoma of the prostate gland who underwent transperineal ultrasound-guided permanent prostate brachytherapy.Methods and Materials: Four hundred twenty-five patients underwent transperineal ultrasound-guided prostate brachytherapy using either Pd-103 or I-125, for clinical T1b-T3a NxMO (1997 AJCC) adenocarcinoma of the prostate gland, from April 1995 to October 1999. No patient underwent pathologic lymph-node staging. One hundred ninety patients were implanted with either Pd-103 or I-125 monotherapy; 235 patients received moderate-dose external beam radiation therapy (EBRT), followed by a prostate brachytherapy boost; 163 patients received neoadjuvant hormonal manipulation, in conjunction with either Pd-103 or I-125 monotherapy (77 patients) or in conjunction with moderate-dose EBRT and a prostate brachytherapy boost (86 patients). The median patient age was 68.0 years (range, 48.2-81.3 years). The median follow-up was 31 months (range, 11-69 months). Follow-up was calculated from the day of implantation. No patient was lost to follow-up. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiation and Oncology (ASTRO) consensus definition.Results: For the entire cohort, the 5-year actuarial biochemical no evidence of disease (bNED) survival rate was 94%. For patients with low-, intermediate-, and high-risk disease, the 5-year biochemical disease-free rates were 97.1%, 97.5%, and 84.4%, respectively. For hormone-naive patients, 95.7%, 96.4%, and 79.9% of patients with low-, intermediate-, and high-risk disease were free of biochemical failure. Clinical and treatment parameters predictive of biochemical outcome included: clinical stage, pretreatment prostate-specific antigen (PSA), Gleason score, risk group, age > 65 years, and neoadjuvant hormonal therapy. Isotope choice was not a statistically significant predictor of disease-free survival for any risk group. The median postimplant PSA was less than or equal to 0.2 for all risk groups, regardless of hormonal status. The mean posttreatment PSA, however, was significantly lower for men implanted with Pd-103 (0.14 ng/mL) than for those implanted with I-125 (0.25 ng/mL), p less than or equal to 0.001.Conclusion: With a median follow-up of 31 months, permanent prostate brachytherapy results in a high probability of actuarial 5-year biochemical disease-free survival (DFS) for patients with clinical T1b-T3a (1997 AJCC) adenocarcinoma of the prostate gland, with an apparent plateau on the PSA survival curve. (C) 2001 Elsevier Science Inc.