- 作者：Charles C. Hsu ; MD ; PhD&lowast ; ; hsucc@radonc.ucsf.edu ; Howard Hsu ; MD¡¬ ; Barby Pickett ; MS&lowast ; ; Gilles Crehange ; MD ; PhD¶ ; ; I-Chow Joe Hsu ; MD&lowast ; ; Ryan Dea ; BS&lowast ; ; Vivian Weinberg ; PhD&Dagger ; ; Alexander R. Gottschalk ; MD ; PhD&lowast ; ; John Kurhanewicz ; PhD§ ; ; Katsuto Shinohara ; MD&dagger ; ; Mack Roach III III ; MD&lowast ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2013
- 出版时间：1 February, 2013
- 年：2013
- 卷：85
- 期：2
- 页码：370-377
- 全文大小：773 K
Purpose
To assess the feasibility of magnetic resonance imaging (MRI)-planned partial salvage permanent prostate implant (psPPI) among patients with biopsy-proven local recurrence after initial PPI without evidence of distant disease.Methods and Materials
From 2003-2009, 15 patients underwent MRI/magnetic resonance spectroscopy (MRS) planning for salvage brachytherapy (psPPI, I-125 [n=14; 144 Gy]; Pd-103 [n=1; 125 Gy]) without hormone therapy. Full dose was prescribed to areas of recurrence and underdosage, without entire prostate implantation. Limiting urethral and rectal toxicity was prioritized. Follow-up was from salvage date to prostate-specific antigen (PSA) concentration failure (Phoenix criteria = nadir + 2.0; ASTRO = 3 consecutive rises), recurrence, distant metastases, or last follow-up PSA level. Progression-free survival (PFS) was defined as no PSA failure or biopsy-proven recurrence without all-cause mortality. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0.
Results
At salvage, median age was 68 years, and PSA concentration was 3.5 ng/mL (range, 0.9-5.6 ng/mL). Abnormal MRI/MRS findings were evident in 40 % of patients. Biopsy-proven recurrences consisted of a single focus (80 % ) or 2 foci (20 % ). At recurrence, Gleason score was 6 (67 % ) or ¡Ý7 (27 % ). Median interval between initial and salvage implantation was 69 months (range, 28-132 months). psPPI planning characteristics limited doses to the rectum (mean V100 = 0.5 % [0.07 cc]) and urethra (V100 = 12 % [0.3 cc]). At median follow-up (23.3 months; range, 8-88 months), treatment failure (n=2) resulted only in localized recurrence; both patients underwent second psPPI with follow-up PSA tests at 12 and 26 months, resulting in 0.6 and 0.7 ng/mL, respectively. American Society for Radiation Oncology PFS rates at 1, 2, and 3 years were 86.7 % , 78.4 % , and 62.7 % , respectively, with 5 patients for whom treatment failed (n=3 with negative transrectal ultrasound-guided biopsy results). Phoenix PFS rates at 1, 2, and 3 years were 100 % , 100 % , and 71.4 % . 73 % , respectively; achieved PSA nadir of <0.5 ng/mL; and 47 % of patients had a nadir of <0.1 ng/mL. Treatment-related toxicity was minimal, with no operative interventions, fistulas, or other grade ¡Ý3 gastrointestinal (GI)/genitourinary (GU) toxicity. Thirteen percent had grade 1 GI and 33 % had grade 2 GU toxicities. Postsalvage, 20 % of patients had no erectile dysfunction, 67 % of patients had medication-responsive erectile dysfunction, and 13 % of patients had erectile dysfunction refractory to medication.
Conclusions
Focal psPPI with MR-planning in highly selected patients is feasible with short-term control comparable to conventional salvage, with less toxicity. Longer follow-up is needed to confirm its impact on quality of life and treatment.