The evolution of brachytherapy for prostate cancer.

The evolution of brachytherapy for prostate cancer.
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DOI:
10.1038/nrurol.2017.76
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发表时间:
2017-06-30
期刊:
Nature reviews. Urology
影响因子:
--
通讯作者:
Horwitz EM
Horwitz EM
中科院分区:
其他
文献类型:
--
作者:
Zaorsky NG;Davis BJ;Nguyen PL;Showalter TN;Hoskin PJ;Yoshioka Y;Morton GC;Horwitz EM

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使用低剂量率(LDR)永久粒子植入或高剂量率(HDR)临时源植入的近距离放射疗法(BT)是任何风险组前列腺癌患者可接受的治疗选择。与LDR-BT相比,HDR-BT的优点包括能够对其他癌症使用相同的来源,对操作者的依赖性较低,并且通常较少出现急性刺激症状。相比之下,LDR-BT的优点包括更有利的调度物流、更低的初始资本设备成本、不需要屏蔽室、单次植入完成以及来自临床试验的更可靠的数据。前瞻性报告比较HDR-BT和LDR-BT彼此或其他治疗方案(如外束放疗(EBRT)或手术)显示相似的结果(证据水平1)。低危、中危、高危患者5年无生化失败率分别为0.85%、69-97%、63-80%。EBRT近距离治疗(相对于单独近距离治疗)是一种适合于中等风险和高风险疾病患者的方法(证据水平1)。10年总生存率、远处转移率和癌症特异性死亡率分别为85%、10%和5%。与HDR-BT和LDR-BT相关的3-4级毒性很少见,在大多数系列中<4%,并且与接受手术的患者相比,接受近距离放疗的患者的生活质量得到改善(证据水平1)。
Brachytherapy BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and — typically — fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes (evidence level 1). The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69–97%, and 63–80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease (evidence level 1). The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3–4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy, compared with those who undergo surgery (evidence level 1).
DOI: 10.1016/j.brachy.2011.01.003
发表时间: 2011-09-01
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