Late urinary morbidity with high dose prostate brachytherapy as a boost to conventional external beam radiation therapy for local and locally advanced prostate cancer.
Late urinary morbidity with high dose prostate brachytherapy as a boost to conventional external beam radiation therapy for local and locally advanced prostate cancer.
复制标题
高剂量前列腺近距离放射治疗作为局部和局部晚期前列腺癌传统外束放射治疗的增强治疗，可降低晚期泌尿道发病率。
作者：
A. Pellizzon;J. Salvajoli;M. Maia;R. Ferrigno;P. Novaes;R. Fogarolli;R. Pellizzon
目的
Late urinary retention (UR) is a known complication that may occur when using high dose rate brachytherapy (HDR-B) to boost external beam radiation therapy (EBRT) when treating prostate cancer.然而，与这种并发症相关的剂量测定、治疗和临床因素尚不清楚。
材料和方法
从 1997 年 3 月到 2000 年 3 月，共有 108 名局部或局部晚期前列腺癌患者接受了 EBRT (45 Gy) 和 HDR-B 作为加强治疗，每天两次，分 4 次给予 16 至 20 Gy。患者中位年龄为 68 岁，中位随访时间为 44 个月（范围 36 至 72 个月）。每次植入使用 8 至 18 根针，中位有效长度为 3 厘米。计划超声目标体积范围为 23 至 65 cc。
结果
尿道区域的生物有效剂量范围为 107 至 138 Gy3（中位数 113）。粗略和 5 年精算无 UR 生存率分别为 95.4% 和 86.2%。单变量分析中 UR 的预测因素为年龄超过 65 岁 (p = 0.0416)、计划超声靶区体积大于 35 cc 以及针的有效长度超过 3.5 cm (p = 0.0158)。在 Cox 回归的多变量分析中，年龄是唯一的预测因素 (p = 0.027)。
结论
HDR-B 似乎提供了一种安全、可重复且有效的方法来加强局部晚期前列腺癌患者的常规 EBRT。这项技术的结果显示，晚期尿路发病率与其他治疗形式的发病率相当，但仍需要进一步的长期随访才能得出明确的结论。
PURPOSE
Late urinary retention (UR) is a known complication that may occur when using high dose rate brachytherapy (HDR-B) to boost external beam radiation therapy (EBRT) when treating prostate cancer. However, the dosimetric, treatment and clinical factors associated with this complication are not well-known.
MATERIALS AND METHODS
From March 1997 to March 2000 a total of 108 patients with local or locally advanced prostate adenocarcinoma were treated with EBRT (45 Gy) and HDR-B as a boost, when 16 to 20 Gy was given in 4 fractions twice daily. Median patient age was 68 years and median followup was 44 months (range 36 to 72). Each implant was performed using 8 to 18 needles with a median active length of 3 cm. Planning ultrasound target volume ranged from 23 to 65 cc.
RESULTS
Biological effective doses for the urethral region ranged from 107 to 138 Gy3 (median 113). Crude and 5-year actuarial UR-free survival were 95.4% and 86.2%, respectively. Predictive factors for UR on univariate analysis were age more than 65 years (p = 0.0416), planning ultrasound target volume greater than 35 cc and active length of needles more than 3.5 cm (p = 0.0158). On multivariate analysis by Cox regression age was the only predictive factor (p = 0.027).
CONCLUSIONS
HDR-B appears to offer a safe, reproducible and effective method of boosting conventional EBRT in patients with locally advanced prostate cancer. Results with this technology reveal late urinary morbidity rates paralleling those achieved with other forms of treatment, but further long-term followup is still needed to warrant a definitive conclusion.