Radiation Oncology Journal

  • 제29권2호
  • /
  • Pages.71-82
  • /
  • 2011
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지
DOI QR코드

DOI QR Code

국소 전립선암의 영구적 근접치료: 조기 결과

Permanent Brachytherapy of Localized Prostate Cancer: Preliminary Results

  • 박혜리 (차의과학대학교 분당차병원 방사선종양학교실) ;
  • 장세경 (차의과학대학교 분당차병원 방사선종양학교실) ;
  • 김자영 (차의과학대학교 분당차병원 방사선종양학교실) ;
  • 이보미 (차의과학대학교 분당차병원 방사선종양학교실) ;
  • 고승영 (차의과학대학교 분당차병원 방사선종양학교실) ;
  • 김성준 (차의과학대학교 분당차병원 방사선종양학교실) ;
  • 신현수 (차의과학대학교 분당차병원 방사선종양학교실)
  • Park, Hye-Li (Department of Radiation Oncology, CHA Bundang Medical Center, CHA University) ;
  • Chang, Sei-Kyung (Department of Radiation Oncology, CHA Bundang Medical Center, CHA University) ;
  • Kim, Ja-Young (Department of Radiation Oncology, CHA Bundang Medical Center, CHA University) ;
  • Lee, Bo-Mi (Department of Radiation Oncology, CHA Bundang Medical Center, CHA University) ;
  • Ko, Seong-Young (Department of Radiation Oncology, CHA Bundang Medical Center, CHA University) ;
  • Kim, Sung-Joon (Department of Radiation Oncology, CHA Bundang Medical Center, CHA University) ;
  • Shin, Hyun-Soo (Department of Radiation Oncology, CHA Bundang Medical Center, CHA University)
  • 투고 : 2011.04.01
  • 심사 : 2011.05.23
  • 발행 : 2011.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적: 국소 전립선암의 영구적 근접치료 후 단기간 추적 관찰 동안의 생화학적 재발률과 부작용의 정도 및 이에 영향을 미치는 인자들에 대해 알아보고자 하였다. 대상 및 방법: 2007년 4월부터 2008년 12월까지 영구적 근접 치료를 시행 받은 환자는 67예이었다. 추적 관찰이 중단된 환자 5명, 이전에 방사선치료를 받았던 환자 2명을 제외한 60예 중 근치적으로 외부 방사선치료를 병용한 16예, 구제 요법으로 외부 방사선치료를 병용한 1예를 제외한 43예를 대상으로 종앙표지인자의 변화와 부작용의 발생 여부를 조사하였다. T1-T2a, Gleason score 6점 이하, prostate specific antigen (PSA) 10 ng/mL 미만의 조건을 모두 충족시킬 경우를 저위험군으로 정의하였으며, T2b-T2c, Gleason score 7점, PSA 10~20 ng/mL 중 한 가지 이상의 조건을 충족시키는 경우를 종간위험군으로 정의하였고, T3a 이상, Gleason score 8~10점, PSA>20 ng/mL 중 한가지 이상의 조건을 총족시키는 경우를 고위험군으로 정의하였다. 저위험군은 18명이었고, 중간위험군은 19명, 고위험군은 6명이었다. 처방선량은 145 Gy이었다. 결 과: 저위험군과 중간위험군에서 각각 1예씩 PSA가 2 ng/mL 이상 증가하여 생화학적 재발로 진단 받았으며(4.7%), 생화학적 재발률에 영향을 미치는 통계적으로 유의한 인자는 없었다. 급성 요로계 부작용의 경우 Radiation Therapy Oncology Group (RTOG) grade 1과 2가 각각 40예, 3예 있었으며, grade 2 이상의 급성 직장 부작용은 없었고 grade 1인 경우가 5예 있었다. 만성 요로계 부작용은 RTOG grade 1, 2, 3이 각각 1 예, 4예, 1예에서 나타났으며, RTOG grade 1, 2의 만성 직장 부작용이 각각 5예, 10예에서 나타났고 직장 요도간 장루가 생긴 grade 4인 경우가 3예 있었다. 부작용의 발생에 통계적으로 유의한 영향을 미치는 요인은 급성 직장염의 경우 전체 직장에서 최고 선량이 조사되는 직장 0.1 cc에 들어가는 최소 선량(p=0.041), 전체 직장 중 처방 선량의 150% 이상이 들어가는 부피(p=0.038), 치료 부위에 포함 된 직장 중 100% 선량이 들어가는 부피(p=0.047) 및 비율(p=0.019)이 있었으며, 급성 요로계 부작용의 경우 seed 개수(p=0.028)가 유의한 영향을 미쳤다. 만성 요로계 부작용에 유의한 영향을 미치는 인자는 없었으며, 만성 직장염의 경우 전체 직장의 100% 처방선량이 들어가는 부피의 비율(p=0,011), 치료 범위 직장에서 100% 처방선량이 들어가는 부피(p=0.023) 및 최고 선량이 조사되는 직장 0.1 cc에 들어가는 최소 선량(p=0.049)이 유의하게 나타났다. 결 론: 국소 전립선암 환자에서 영구적 근접치료는 저위험군 환자뿐 아니라 중간위험군이나 고위험군 환자에게도 선택적으로 적용 가능한 치료 방법이라고 생각되며 직장 부작용을 감소시키기 위한 노력이 필요하다고 생각된다.

Purpose: To evaluate the biochemical control rate and the rate of side effects after performing permanent brachytherapy of localized prostate cancer. Materials and Methods: 67 patients with localized prostate cancer were treated with brachytherapy between April 2007 and December 2008. Of these, 43 patients who were followed up and did not receive external radiotherapy were evaluated for the change in prostate specific antigen (PSA) level and the occurrence of side effects. In total, 18 patients were classified as low risk, 19 patients as intermediate risk, and 6 patients as high risk. The prescription dose was 145 Gy. Results: A PSA increase greater than 2 ng/mL occurred in 2 patients (4.7%). Radiation Therapy Oncology Group (RTOG) grade 1 and 2 acute urologic complications (UC) occurred in 40 and 3 patients, respectively. Further, 5 patients had RTOG grade 1 acute rectal complication (RC). The numbers of RTOG grade 1, 2, and 3 chronic UC were 1, 4, and 1, respectively. The numbers of RTOG grade 1, 2, and 4 chronic RC were 5, 10, and 3, respectively. The statistically significant risk factors (RF) of acute RC were the minimal dose in the most irradiated 0.1 cc volume ($D_{0.1cc}$, p=0.041) and absolute volume receiving 150% of the prescribed dose ($V_{150cc}$, p=0.038) in the entire rectum (ER). The percentage ($V_{100%}$, p=0.019) and absolute volume ($V_{100cc}$, p=0.047) in the involved rectum (IR) were also statistically significant. The RF of chronic RC were $V_{100%}$ (p=0.011) in the ER and the $D_{0.1cc}$ (p=0.049), $V_{100cc}$ (p=0.023) in the IR. The number of used seeds were related with acute UC (p=0.028). Conclusion: Permanent brachytherpy of localized prostate cancer showed a favorable short term biochemical control rate. As such, selective intermediate and high risk patients can be managed with permanent brachytherapy. The effort to reduce rectal complication is also necessary.

키워드

참고문헌

  1. Marcus DM, Jani AB, Godette K, Rossi PJ. A review of low-dose-rate prostate brachytherapy: techniques and outcomes. J Natl Med Assoc 2010;102:500-510 https://doi.org/10.1016/S0027-9684(15)30559-9
  2. Henderson A, Laing RW, Langley SE. Quality of life following treatment for early prostate cancer: does low dose rate (LDR) brachytherapy offer a better outcome? A review. Eur Urol 2004;45:134-141 https://doi.org/10.1016/j.eururo.2003.09.015
  3. Taira AV, Merrick GS, Galbreath RW, Wallner KE, Butler WM. Natural history of clinically staged low- and intermediate-risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2010;76:349-354 https://doi.org/10.1016/j.ijrobp.2009.02.021
  4. Taira AV, Merrick GS, Butler WM, et al. Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2011;79:1336-1342 https://doi.org/10.1016/j.ijrobp.2010.01.005
  5. Kupelian PA, Elshaikh M, Reddy CA, Zippe C, Klein EA. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy. J Clin Oncol 2002;20:3376-3385 https://doi.org/10.1200/JCO.2002.01.150
  6. Smith RP, Jones HA, Beriwal S, Gokhale A, Benoit R. Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants. Int J Radiat Oncol Biol Phys 2010. 2010 Sep 30 [Epub]. DOI:10.1016/j.ijrobp.2010.06.01
  7. Ferrer M, Suarez JF, Guedea F, et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2008;72:421-432 https://doi.org/10.1016/j.ijrobp.2007.12.024
  8. Crook JM, Potters L, Stock RG, Zelefsky MJ. Critical organ dosimetry in permanent seed prostate brachytherapy: defining the organs at risk. Brachytherapy 2005;4:186-194 https://doi.org/10.1016/j.brachy.2005.01.002
  9. Roach M 3rd, Hanks G, Thames H Jr, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006;65:965-974 https://doi.org/10.1016/j.ijrobp.2006.04.029
  10. Kuban DA, Levy LB, Potters L, et al. Comparison of biochemical failure definitions for permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2006;65:1487-1493 https://doi.org/10.1016/j.ijrobp.2006.03.027
  11. Potters L, Huang D, Calugaru E, Fearn P, Lee L, Kattan MW. Importance of implant dosimetry for patients undergoing prostate brachytherapy. Urology 2003;62:1073-1077 https://doi.org/10.1016/j.urology.2003.07.004
  12. Blasko JC, Grimm PD, Sylsvester JE, Cavanagh W. The role of external beam radiotherapy with I-125/Pd-103 brachytherapy for prostate carcinoma. Radiother Oncol 2000;57:273-278 https://doi.org/10.1016/S0167-8140(00)00288-7
  13. Lee LN, Stock RG, Stone NN. Role of hormonal therapy in the management of intermediate- to high-risk prostate cancer treated with permanent radioactive seed implantation. Int J Radiat Oncol Biol Phys 2002;52:444-452 https://doi.org/10.1016/S0360-3016(01)02598-6
  14. Dosoretz AM, Chen MH, Salenius SA, et al. Mortality in men with localized prostate cancer treated with brachytherapy with or without neoadjuvant hormone therapy. Cancer 2010;116:837-842 https://doi.org/10.1002/cncr.24750
  15. D'Amico AV, Moran BJ, Braccioforte MH, et al. Risk of death from prostate cancer after brachytherapy alone or with radiation, androgen suppression therapy, or both in men with high-risk disease. J Clin Oncol 2009;27:3923-3928 https://doi.org/10.1200/JCO.2008.20.3992
  16. Hoffman KE, Chen MH, Moran BJ, et al. Prostate cancer-specific mortality and the extent of therapy in healthy elderly men with high-risk prostate cancer. Cancer 2010;116:2590-2595 https://doi.org/10.1002/cncr.24974
  17. Expert Panel on Radiation Oncology-Prostate, Frank SJ, Arterbery VE, et al. American College of Radiology appropriateness criteria permanent source brachytherapy for prostate cancer. Brachytherapy 2011. 2011 Apr 16 [Epub]. DOI:10.1016/j.brachy.2011.01.014
  18. Nag S, Beyer D, Friedland J, Grimm P, Nath R. American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 1999;44:789-799 https://doi.org/10.1016/S0360-3016(99)00069-3
  19. Nag S, Bice W, DeWyngaert K, Prestidge B, Stock R, Yu Y. The American Brachytherapy Society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis. Int J Radiat Oncol Biol Phys 2000;46:221-230 https://doi.org/10.1016/S0360-3016(99)00351-X
  20. Chauveinc L, Flam T, Solignac S, et al. Prostate cancer brachytherapy: is real-time ultrasound-based dosimetry predictive of subsequent CT-based dose distribution calculation? A study of 450 patients by the Institut Curie/Hospital Cochin (Paris) Group. Int J Radiat Oncol Biol Phys 2004;59:691-695 https://doi.org/10.1016/j.ijrobp.2003.12.003
  21. Salembier C, Lavagnini P, Nickers P, et al. Tumour and target volumes in permanent prostate brachytherapy: a supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy. Radiother Oncol 2007;83:3-10 https://doi.org/10.1016/j.radonc.2007.01.014
  22. Phan J, Swanson DA, Levy LB, Kudchadker RJ, Bruno TL, Frank SJ. Late rectal complications after prostate brachytherapy for localized prostate cancer: incidence and management. Cancer 2009;115:1827-1839 https://doi.org/10.1002/cncr.24223
  23. Wallner K, Roy J, Harrison L. Tumor control and morbidity following transperineal iodine 125 implantation for stage T1/T2 prostatic carcinoma. J Clin Oncol 1996;14:449-453
  24. Willins J, Wallner K. CT-based dosimetry for transperineal I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys 1997;39:347-353
  25. Kleinberg L, Wallner K, Roy J, et al. Treatment-related symptoms during the first year following transperineal 125I prostate implantation. Int J Radiat Oncol Biol Phys 1994;28:985-990 https://doi.org/10.1016/0360-3016(94)90119-8
  26. Snyder KM, Stock RG, Hong SM, Lo YC, Stone NN. Defining the risk of developing grade 2 proctitis following 125I prostate brachytherapy using a rectal dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 2001;50:335-341 https://doi.org/10.1016/S0360-3016(01)01442-0
  27. Waterman FM, Dicker AP. Probability of late rectal morbidity in 125I prostate brachytherapy. Int J Radiat Oncol Biol Phys 2003;55:342-353 https://doi.org/10.1016/S0360-3016(02)03934-2
  28. Albert M, Song JS, Schultz D, et al. Defining the rectal dose constraint for permanent radioactive seed implantation of the prostate. Urol Oncol 2008;26:147-152 https://doi.org/10.1016/j.urolonc.2007.03.026
  29. Han BH, Wallner KE. Dosimetric and radiographic correlates to prostate brachytherapy-related rectal complications. Int J Cancer 2001;96:372-378 https://doi.org/10.1002/ijc.1037
  30. Crook J, McLean M, Catton C, Yeung I, Tsihlias J, Pintilie M. Factors influencing risk of acute urinary retention after TRUS-guided permanent prostate seed implantation. Int J Radiat Oncol Biol Phys 2002;52:453-460 https://doi.org/10.1016/S0360-3016(01)02658-X
  31. Merrick GS, Butler WM, Wallner KE, Lief JH, Galbreath RW. Prophylactic versus therapeutic alpha-blockers after permanent prostate brachytherapy. Urology 2002;60:650-655 https://doi.org/10.1016/S0090-4295(02)01840-X
  32. Merrick GS, Butler WM, Wallner KE, et al. Impact of supplemental external beam radiotherapy and/or androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005;61:32-43 https://doi.org/10.1016/j.ijrobp.2004.05.003
  33. Pinkawa M, Fischedick K, Piroth MD, et al. Healthrelated quality of life after permanent interstitial brachytherapy for prostate cancer: correlation with postimplant CT scan parameters. Strahlenther Onkol 2006;182:660-665 https://doi.org/10.1007/s00066-006-1530-z
  34. Masucci GL, Donath D, Tetreault-Laflamme A, et al. Comparison between high and low source activity seeds for I-125 permanent seed prostate brachytherapy. Int J Radiat Oncol Biol Phys 2010;78:781-786 https://doi.org/10.1016/j.ijrobp.2009.08.057
  35. Lee N, Wuu CS, Brody R, et al. Factors predicting for postimplantation urinary retention after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2000;48:1457-1460 https://doi.org/10.1016/S0360-3016(00)00784-7
  36. Kumar S, Shelley M, Harrison C, Coles B, Wilt TJ, Mason MD. Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database Syst Rev 2006;(4):CD006019
  37. Bria E, Cuppone F, Giannarelli D, et al. Does hormone treatment added to radiotherapy improve outcome in locally advanced prostate cancer? Meta-analysis of randomized trials. Cancer 2009;115:3446-3456 https://doi.org/10.1002/cncr.24392
  38. Potters L, Torre T, Ashley R, Leibel S. Examining the role of neoadjuvant androgen deprivation in patients undergoing prostate brachytherapy. J Clin Oncol 2000;18:1187-1192 https://doi.org/10.1200/JCO.2000.18.6.1187