Salvage permanent perineal radioactive-seed implantation for treating recurrence of localized prostate adenocarcinoma after external beam radiotherapy
Salvage permanent perineal radioactive-seed implantation for treating recurrence of localized prostate adenocarcinoma after external beam radiotherapy
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DOI：
10.1111/j.1464-410x.2009.08445.x
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发表时间：
2009-09-01
影响因子：
4.5
通讯作者：
Shinohara, Katsuto
中科院分区：
文献类型：
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作者：
Aaronson, David S.;Yamasaki, Ichiro;Shinohara, Katsuto
目的评价会阴永久性放射性粒子植入(SPPI)治疗复发性前列腺癌的经验，因为对局限性前列腺癌的根治性外照射(EBRT)后复发的挽救治疗与明显的并发症和生化失败有关。排除的是接受过其他主要治疗或没有随访的患者。主要结果是生化无复发生存时间，使用菲尼克斯定义的前列腺特异性抗原(PSA)最低水平+2 ng/毫升，以及癌症特异性存活率。次要结果是国际前列腺症状评分(IPSS)、国际勃起功能指数-5评分(IIEF-5)和基于不良事件通用术语标准(版本3)的并发症。结果在此期间共有37例患者出现SPPI；在应用纳入和排除标准后，仍有24例有待分析。在抢救治疗时，诊断局部复发的中位时间为49个月，中位PSA水平为3.36 ng/m L，中位PSA倍增时间为20个月，所有患者均于术后2个月经直肠超声和/或磁共振检查阴性进行临床再分期。原始Gleason评分：9例<lt；6分，8例<7分，3例<8分(2例未记入)。SPPI术后中位随访期为30个月，无癌生存率96%(1例死亡)，生化无复发生存率88%(3例)。在所有三个失败的患者中，PSA水平在3个月时都高于SPPI前的水平，但在所有21名被认为是无复发的患者中，PSA水平都低于SPPI前的水平。并发症包括1例尿道狭窄，1例3级直肠出血，5例2级肉眼血尿，均经保守治疗后痊愈。没有足够的数据来评估IPSS或IIEF-5评分。结论在短期的随访中，SPPI似乎为前列腺癌EBRT后局部复发的患者提供了良好的前列腺癌控制和可接受的并发症发生率。为了确定SPPI的长期耐久性和安全性，有必要进行长期的随访。
OBJECTIVETo assess our experience with salvage permanent perineal radioactive-seed implantation (SPPI) as a possible therapeutic option for recurrent prostate adenocarcinoma, as salvage therapies for recurrences after definitive external beam radiotherapy (EBRT) for localized adenocarcinoma of the prostate are associated with significant morbidity and biochemical failure.PATIENTS AND METHODSWe retrospectively analysed on patients who had SPPI for localized recurrent prostate adenocarcinoma from 1996 to 2007 after primary treatment with EBRT. Excluded were patients who had other primary treatment or had no follow-up. Primary outcomes were time to biochemical relapse-free survival, using the Phoenix definition of a prostate-specific antigen (PSA) nadir +2 ng/mL, and cancer-specific survival. Secondary outcomes were the International Prostate Symptom Score (IPSS), the International Index of Erectile Function-5 score (IIEF-5), and complications based on Common Terminology Criteria for Adverse Events (version 3).RESULTSIn all, 37 patients had SPPI during this period; after applying inclusion and exclusion criteria, 24 remained for analysis. At the time of salvage therapy, the median time to the diagnosis of local recurrence was 49 months, the median PSA level was 3.36 ng/mL, the median PSA doubling time was 20 months, and all patients were clinically re-staged at < T2 with negative transrectal ultrasonography and/or magnetic resonance spectroscopy. The original Gleason score was < 6 in nine patients, 7 in eight and >= 8 in three (not recorded in two). The median follow-up after SPPI was 30 months; the cancer-free survival was 96% (one death) and biochemical relapse-free survival was 88% (three patients). The PSA level was higher than the levels before SPPI at 3 months in all three failures, but lower in all 21 patients considered relapse-free. Complications included one urethral stricture, one grade 3 rectal haemorrhage and five grade 2 gross haematuria that resolved with conservative management. Insufficient data were available to assess the IPSS or IIEF-5 scores.CONCLUSIONWith a short-term follow-up SPPI appears to provide excellent prostate cancer control with an acceptable rate of complications for patients with local recurrence of prostate cancer after EBRT. An extended follow-up is necessary to determine the long-term durability and safety of SPPI.