High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer
High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer
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DOI：
10.1016/j.eururo.2004.11.014
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发表时间：
2005-04-01
期刊：
影响因子：
23.4
通讯作者：
Loening, SA
中科院分区：
文献类型：
--
作者：
Deger, S;Boehmer, D;Loening, SA
目的：目的：评价高剂量率（HDR）铱192（Ir-192）近距离放射治疗和三维适形外照射治疗局限性前列腺癌的疗效。方法：1992年12月至2001年3月，共442例局限性前列腺癌患者接受了Ir-192组织间近距离放射治疗和三维适形外照射联合放疗。患者接受腹腔镜盆腔淋巴结清扫术，以排除淋巴受累患者。铱192后装植入两次，间隔一周。247例患者（56%）患有临床T3疾病，128例患者（29%）的初始PSA超过20 ng/ml。根据ASTRO标准，进展定义为生化失败。根据独立影响前列腺特异性抗原（PSA）无复发生存率的治疗前变量，将患者分为三个风险组。低风险定义为cT 1c-cT 2和G1-G2和PSA < 10 ng/ml（n = 94）。中等风险包括cT 1c-cT 2和G1-G2且PSA在10 - 20 ng/ml之间的患者（n = 53）。高危组患者为cT 3或G3或PSA > 20 ng/ml（n = 295）。50例（11%）患者发生了RTOG/EORTC标准的3-4级晚期并发症，治疗后12个月PSA中位数从11.8ng/ml降至0.98ng/ml，60个月降至0.3ng/ml，10年降至0.1ng/ml。53%的患者（n = 235）达到PSA最低值0.5 ng/ml。66例患者（15%）局部复发，54例（12%）发展为全身性疾病，12例（3%）局部和全身性衰竭。5年随访时无进展生存率为65%。低危组5年无进展生存率为81%，中危组为65%，高危组为59%。5年总生存率为87%，5年疾病特异性生存率为94%。初始PSA值，风险组和年龄显着相关的无进展survival.Conclusions：结合HDR近距离放射治疗与铱192是一种替代治疗选择局限性前列腺癌患者。初始PSA值、危险组和年龄是无进展生存期的重要预后因素。(c)2004 Elsevier B. V.保留所有权利。
Objectives: To evaluate the outcome of high dose rate (HDR) brachytherapy with iridium 192 (Ir-192) and 3D conformal external beam radiotherapy in patients with localized prostate cancer.Methods: A total of 442 patients with localized prostate cancer underwent combined radiotherapy with interstitial brachytherapy with Ir-192 and 3D conformal external beam radiotherapy between December 1992 and March 2001. Patients underwent laparoscopic pelvic lymph node dissection to exclude patients with lymphatic involvement. Iridium 192 was delivered twice with a one-week interval in afterloading technique. 247 patients (56%) had clinical T3 disease and 128 patients (29%) had an initial PSA of more than 20 ng/ml. Progression was defined as biochemical failure according to ASTRO criteria. Patients were diveded according to pretreatment variables that independently affected prostate-specific antigen (PSA) relapse-free survival in three risk groups. Low risk was defined as cT1c-cT2 and G1-G2 and PSA < 10 ng/ml (n = 94). Intermediate risk included patients with cT1c-cT2 and G1-G2 and PSA between 10 and 20 ng/ml (n = 53). High risk group patients were cT3 or G3 or PSA > 20 ng/ml (n = 295).Results: Median follow-up was 5 years. Late grade 3-4 complications according to RTOG/EORTC criteria occurred in 50 patients (11%).The initial PSA value decreased from median 11.8 ng/ml to 0.98 ng/ml 12 months after treatment, to 0.3 ng/ml after 60 months and to 0.1 ng/ml 10 years after therapy. 53% of the patients (n = 235) reached a PSA nadir of 0.5 ng/ml. 66 patients (15%) had a local recurrence, 54 (12%) developed systemic disease and 12 (3%) had both local and systemic failure. The progression free survival rate was 65% at 5-year follow-up. Five-year progression free survival was 81% in the low risk group, 65% in the intermediate risk group and 59% in the high risk group. Five-year overall survival was 87% and 5-year disease specific survival 94%. Initial PSA value, risk group and age were significantly related to progression free survival.Conclusions: Combined HDR brachytherapy with Iridium 192 is an alternative treatment option for patients with localized prostate cancer. Initial PSA value, risk group, and age are important prognostic factors for progression free survival. (c) 2004 Elsevier B.V. All rights reserved.