EQUIVALENT BIOCHEMICAL CONTROL AND IMPROVED PROSTATE-SPECIFIC ANTIGEN NADIR AFTER PERMANENT PROSTATE SEED IMPLANT BRACHYTHERAPY VERSUS HIGH-DOSE THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY AND HIGH-DOSE CONFORMAL PROTON BEAM RADIOTHERAPY BOOST

作者：Jabbari Siavash; Weinberg Vivian K; Shinohara Katsuto; Speight Joycelyn L; Gottschalk Alexander R; Hsu I Chow; Pickett Barby; McLaughlin Patrick W; Sandler Howard M; Roach Mack III^*

来源：International Journal of Radiation Oncology, Biology, Physics, 2010, 76(1): 36-42.

DOI：10.1016/j.ijrobp.2009.01.029

• Prostate cancer
• Permanent prostate implant brachytherapy
• PPI
• Proton radiotherapy
• Three-dimensional conformal radiotherapy
• 3D-CRT
• Prostate-specific antigen
• PSA nadir

Purpose: Permanent prostate implant brachytherapy (PPI), three-dimensional conformal radiotherapy (3D-CRT), and conformal proton beam radiotherapy (CPBRT) are used in the treatment of localized prostate cancer, although no head-to-head trials have compared these modalities. We studied the biochemical control (biochemical no evidence of disease [bNED]) and prostate-specific antigen (PSA) nadir achieved with contemporary PPI, and evaluated it against 3D-CRT and CPBRT.
Patients and Methods: A total of 249 patients were treated with PPI at the University of California, San Francisco, and the outcomes were compared with those from a 3D-CRT cohort and the published results of a high-dose CPBRT boost (CPBRTB) trial. For each comparison, subsets of the PPI cohort were selected with patient and disease criteria similar to those of the reference group.
Results: With a median follow-up of 5.3 years, the bNED rate at 5 and 7 years achieved with PPI was 92% and 86%, respectively, using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, and 93% using the PSA nadir plus 2 ng/mL definition. Using the ASTRO definition, a 5-year bNED rate of 78% was achieved for the 3D-CRT patients compared with 94% fora comparable PPI subset and 93% vs. 92%, respectively, using the PSA nadir plus 2 ng/mL definition. The median PSA nadir for patients treated with PPI and 3D-CRT was 0.10 and 0.40 ng/mL, respectively (p < .0001). For the CPBRT comparison, the 5-year bNED rate after a CPBRTB was 91% using the ASTRO definition vs. 93% for a similar group of PPI patients. A greater proportion of PPI patients achieved a lower PSA nadir compared with those achieved in the CPBRTB trial (PSA nadir <= 0.5 ng/mL, 91% vs. 59%, respectively).
Conclusion: We have demonstrated excellent outcomes in low- to intermediate-risk patients treated with PPI, suggesting at least equivalent 5-year bNED rates and a greater proportion of men achieving lower PSA nadirs compared with 3D-CRT or CPBRTB.

• 出版日期2010-1-1