Long-term outcomes of partial prostate treatment with magnetic resonance imaging-guided brachytherapy for patients with favorable-risk prostate cancer.
Long-term outcomes of partial prostate treatment with magnetic resonance imaging-guided brachytherapy for patients with favorable-risk prostate cancer.
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DOI：
10.1002/cncr.31568
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发表时间：
2018-09-01
期刊：
影响因子：
6.2
通讯作者：
Orio PF 3rd
中科院分区：
文献类型：
--
作者：
King MT;Nguyen PL;Boldbaatar N;Tempany CM;Cormack RA;Beard CJ;Hurwitz MD;Suh WW;D'Amico AV;Orio PF 3rd
部分前列腺癌治疗已成为一种潜在的方法，用于治疗风险较高的前列腺癌，同时将毒性降至最低。我们先前显示，对于国家癌症中心网络(NCCN)的中等风险疾病，采用近距离放射治疗部分腺体的生化控制率很低。我们的目的是评估这一队列的远处转移率和前列腺癌特异性死亡率(PCSM)。1997年至2007年间，354名临床T1c、前列腺特异性抗原(PSA)<15 ng/ml、Gleason 3+4或以下前列腺癌患者在0.5特斯拉MR引导下接受了部分前列腺癌的近距离放射治疗，治疗范围为MR定义的周边区。估计NCCN极低、低、中风险组的累积转移率和PCSM发生率。Fine和Gray的竞争风险回归用于评估与转移时间相关的临床因素。22例患者发生转移，中位时间为11.0年(四分位数范围：6.9-13.9)。极低、低和中危疾病的12年转移率分别为0.8%(95%可信区间)0.1-4.4%、8.7%(3.4-17.2)和15.7%(5.7-30.2)。12年PCSM估计分别为1.6%(0.1-7.6)、1.4%(0.1-6.8)和8.2%(1.9-20.7)。多因素分析显示，NCCN风险类别(低风险比：6.34(1.18-34.06)，p=0.03；中风险比：6.98(1.23-39.73)；p=0.03)与转移时间显著相关。部分前列腺癌的近距离放射治疗可能与长期随访后较高的远处转移率和中危疾病的PCSM相关。对于这个队列，少于整个腺体的治疗可能并不合适。
Partial prostate treatment has emerged as a potential method for treating favorable-risk prostate cancer while minimizing toxicity. We had previously shown poor rates of biochemical control for National Cancer Center Network (NCCN) intermediate risk disease with partial gland treatment with brachytherapy. Our purpose is to estimate the rates of distant metastasis and prostate cancer specific mortality (PCSM) for this cohort. Between 1997 and 2007, 354 men with clinical T1c, prostate specific antigen (PSA) < 15 ng/mL, Gleason 3+4 or less prostate cancer underwent partial prostate treatment with brachytherapy to the MR defined peripheral zone under 0.5 Tesla MR-guidance. The cumulative incidences of metastasis and PCSM for NCCN very low, low, and intermediate risk groups were estimated. Fine and Gray’s competing risk regression was utilized to evaluate clinical factors associated with times to metastasis. Twenty-two patients developed metastases at a median of 11.0 years (interquartile range: 6.9-13.9). Twelve-year metastasis rates for very low, low, and intermediate risk disease were 0.8% (95% confidence interval) 0.1-4.4%), 8.7% (3.4-17.2), and 15.7% (5.7-30.2), respectively. Respective 12 year PCSM estimates were 1.6% (0.1-7.6), 1.4% (0.1-6.8), and 8.2% (1.9-20.7). On multivariate analysis, NCCN risk category (low risk hazard ratio: 6.34 (1.18-34.06), p = 0.03; intermediate risk: 6.98 (1.23-39.73); p = 0.03) was significantly associated with the time to metastasis. Partial prostate treatment with brachytherapy may be associated with higher rates of distant metastasis and PCSM for intermediate risk disease after long-term follow-up. Treatment of less than the full gland may not be appropriate for this cohort.
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DOI：
10.1200/jco.2015.62.5764
发表时间：
2015-10-20
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
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DOI：
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影响因子：
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