LONG-TERM OUTCOMES OF HIGH-DOSE-RATE BRACHYTHERAPY PLUS EXTERNAL-BEAM RADIOTHERAPY FOR LOCALIZED PROSTATE CANCER

以高劑量率近接治療加上體外射束放射治療對侷限性攝護腺癌的長期治療成果

陳彥超(Yen-Chao Chen) ； 莊正鏗(Cheng-Keng Chuang) ； 謝明里(Ming-Li Hsieh) ； 陳文政(Wen-Cheng Chen) ； 范綱行(Kang-Hsing Fan) ； 洪志宏(Ji-Hong Hong)

《放射治療與腫瘤學》 23卷4期 (2016/12) Pp. 229-236

https://doi.org/10.6316/TRO/201623(4)229

摘要

Purpose : To report 8-year long-term outcomes for localized prostate cancer patients treated with the combination of high-dose-rate brachytherapy (HDR-BT) and external beam radiotherapy (EBRT). Materials and Methods : One hundred and twenty-one Stage T1c to T3b prostate cancer patients treated with HDR-BT plus EBRT were included. An HDR dose of 16.5 Gy in 3 fractions over 24 hours was given 2 weeks before EBRT. An EBRT dose of 50.4 Gy was administered to the prostate and seminal vesicles. Younger patients (aged under 75 years) with greater than 15% risk of nodal metastasis received whole-pelvis RT (45 Gy in 25 fractions) as part of EBRT. Results : Forty-nine percent of patients belonged to the high-risk (T3a or Gleason score 8–10 or prostate specific antigen greater than 20 ng/mL) or very-high-risk (T3b) groups. After a median follow-up of 125 months (range, 22-168 months), 8-year biochemical control rate was 80% (100%, 90%, 71%, and 20% respectively, for patients in the low, intermediate, high, and very-high-risk groups). Biochemical failure was noted in 25 patients. Two patients experienced late biochemical failure (108 and 129 months after EBRT). 8-year overall and cancer-specific survivals were 91% and 99%. Six patients (5%) had grade 3 implant-related acute urinary retention due to hematuria. Chronic gastrointestinal (GI) toxicities were limited, but 7 (6%) patients had episodes of grade 3 chronic genitourinary (GU) toxicities, including urethral stricture and severe hematuria. Whole-pelvis EBRT is a major contributing factor to acute but not to chronic GI toxicities. Among 84 patients with pretreatment sexual potency, 30% retained potency at 5 years. Conclusion : HDR-BT plus EBRT can achieve satisfactory long-term biochemical control with acceptable complications for T1c-T3a prostate cancer patients.

關鍵字

Prostate cancer ； HDR-brachytherapy ； Radiotherapy

並列摘要

目的：報告以高劑量率近接治療（high-dose-rate brachytherapy, HDR-BT）加上體外射束放療（external beam radiotherapy, EBRT）對侷限性攝護腺癌（localized prostate cancer）的長期治療成果。材料與方法：本研究收錄了 121 位以 HDR-BT 加上 EBRT 治療的 T1c 至 T3b 期攝護腺癌病人。HDR-BT 劑量共 16.5 Gy，於體外射束放療前兩週，分三次於二十四小時內給予。體外射束放療50.4 Gy 照射於攝護腺和儲精囊。若病人年紀小於 75 歲並且淋巴轉移風險大於 15%，則起始的45 Gy/ 25 次涵蓋全骨盆腔。結果：百分之四十九的病人屬於高風險（T3a 或 Gleason 分數 8-10 或 PSA 大於 20 ng/ml）或非常高風險（T3b）族群。中位追蹤時間為 125 個月（範圍：22-168 個月）。八年的的生化控制率（biochemical control rate）為 80%（對於低、中、高、非常高風險族群的病人，其數字則分別為 100%，90%，71%和 20%）有兩位病人在體外射束放療結束後很久（108 和 129 個月）才產生生化上的失敗（biochemical failure）。八年的總體存活率（Overall Survival）和癌症特定存活率（cancer-specific survival）分別為 91%和 99%。有六位病人（5%）因血尿導致的急性尿滯留（acute urinary retention）產生第三級的插針相關（implant-related）急性副作用。胃腸道（gastrointestinal）的慢性副作用並不顯著，但有七位病人（6%）因尿道狹窄（urinary stricture）和嚴重血尿（severe hematuria）而被歸為第三級的泌尿道（genitourinary）副作用。全骨盆腔照射會增加胃腸道的急性副作用但非慢性副作用。在 83 位治療前性功能良好的病人，有 30%在治療後五年仍保有其性能力。結論：對於 T1c 至 T3a 的攝護腺癌病人，HDR-BT 搭配 EBRT 可達到滿意的長期生化控制率並可接受的副作用結果。

並列關鍵字

攝護腺癌 ； 高劑量率近接治療 ； 放射治療