High Dose Brachytherapy as Monotherapy for Intermediate Risk Prostate Cancer

被引:69
作者
Rogers, C. Leland [1 ]
Alder, Stephen C. [2 ]
Rogers, R. LeGrand [3 ]
Hopkins, Scott A. [4 ]
Platt, McKay L. [5 ]
Childs, Lane C. [4 ]
Crouch, Ronald H. [6 ]
Hansen, Roger S. [1 ]
Hayes, John K. [1 ]
机构
[1] GammaW Canc Serv, Salt Lake City, UT 84102 USA
[2] Univ Utah, Dept Family & Prevent Med, Salt Lake City, UT USA
[3] Univ Utah, Sch Med, Salt Lake City, UT USA
[4] Westen Urol, Salt Lake City, UT USA
[5] Cent Utah Urol, Provo, UT USA
[6] Urol Associates, Cedar City, UT USA
关键词
prostate; prostatic neoplasms; brachytherapy; neoplasm staging; mortality; EXTERNAL-BEAM RADIOTHERAPY; PERMANENT INTERSTITIAL BRACHYTHERAPY; ERECTILE FUNCTION IIEF-5; RADICAL PROSTATECTOMY; ANDROGEN SUPPRESSION; INTERNATIONAL INDEX; RADIATION-THERAPY; SEED IMPLANTATION; RANDOMIZED-TRIAL; DIAGNOSTIC-TOOL;
D O I
10.1016/j.juro.2011.09.050
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We evaluated our retrospective, single institution experience with high dose rate brachytherapy as monotherapy for intermediate risk prostate cancer. Materials and Methods: Our cohort included 284 patients with intermediate risk prostate cancer, defined as clinical stage T2b/T2c, Gleason score 7 and/or prostate specific antigen 10 to 20 ng/ml, and 1-year minimum followup. Treatment was 2 high dose rate brachytherapy sessions at 3 fractions of 6.5 Gy each for a mean of 19 days. Prostate specific antigen failure was defined as nadir +2 ng/ml. Results: Mean followup was 35.1 months (median 31.9). Actuarial 5-year cause specific survival and clinical local control were 100%, distant-metastasis-free survival 98.8% and biochemical disease-free survival 94.4%. Clinical stage predicted biochemical disease-free survival. For stage T2a or less 5-year biochemical disease-free survival was 95.1% vs 100% for stage T2b and 77.4% for T2c (p = 0.012). Percent positive biopsy cores and prostate specific antigen nadir were also predictive. International Prostate Symptom Score results remained stable and potency was maintained in 82.6% of patients at 2 years. Pads were used for the first time after brachytherapy in 22 patients (7.7%), mostly for grade 1 incontinence (occasionally or less per week). Excluding patients with prior transurethral prostatectomy, stroke or tremor 2.5% used pads for the first time after treatment. No patient had urethral stricture. Radiation Therapy Oncology Group grade 1 rectal toxicity developed in 12 patients (4.2%) but not beyond grade 1. Conclusions: High dose rate brachytherapy as monotherapy is safe and effective for patients with intermediate risk prostate cancer. We recommend caution for percent positive biopsy cores exceeding 75% or clinical stage T2c. Excluding such patients the 5-year biochemical disease-free survival rate was 97.5%.
引用
收藏
页码:109 / 116
页数:8
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