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:
影响因子:
--
通讯作者:
Horwitz EM
中科院分区:
文献类型:
--
作者:
Zaorsky NG;Davis BJ;Nguyen PL;Showalter TN;Hoskin PJ;Yoshioka Y;Morton GC;Horwitz EM
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).
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