前立腺癌放射線治療後の PSA 再症例に対する

1 1 PSA I/II PhaseI/II study of focal salvage high-dose-rate brachytherapy for patient with PSA-failure after radiotherapy for prostate cancer 701-0192 577 TEL 086-462-1111 FAX 086-462-1199 E-mail: 2011 4 25 1 2011 6 4 2 2011 7 7 3 2011 7 27 4 2011 8 3 5 2011 8 18 6 2 BT brachytherapy CE-Dyn contrast-enhanced dynamic CTCAE common terminology criteria for adverse events CTV clinical target volume DVH dose volume histogram EPIC expanded prostate cancer instrument composite GS Gleason score GTV gross tumor volume HDR high-dose-rate IPSS international prostate symptom score JASTRO the Japanese Society for Therapeutic Radiology and Oncology LDR low-dose-rate performance scale PSA prostate specific antigen

2 PTV planning target volume QOL quality of life SF-8 rand medical outcomes study 8-item health survey TRUS Trans-rectal ultrasound TUR-BT Trans-urethral resection of the bladder tumor TUR-P trans-urethral resection of the prostate 3 0 1 2 10 3. 10 4. 11 5. 14 6.

3 16 4 7 17 8 19 9 22 ( ) 10. 23 11. 24 12. 24 5 13.

4 25 14. 27 SF-8, EPIC IPSS 6 0. iPSA, GS, T CT MRI cT1c-3aN0M0,PSA 20ng/ml,any GS 12 72Gy PSA Phoenix rT1c-2bN0M0 2 PSA<10ng/ml PSA 6 6 20 2011 10 2013 3 31 2016 3 31 3 1 22Gy/2 /2 7 -HDR 3 3.

5 1 22Gy/2 /2 Focal salvage HDR-BT 72Gy 1 iPSA initial-PSA ,GS,T CT MRI cN0M0 cT1c-3aN0M0,PSA 20ng/ml,anyGS rT1c-2bN0M0 12 * * 22 2 PSA 6 6 CTV=PTV 22Gy/2 6 6 PSA 1 Primary endpoint 2 Secondary endpoint 20 2011 10 2013 3 31 2016 3 31 3 8 3 135-8550 3-10-6 TEL: 03-3520-0111( ) TEL.

6 03-3570-0341 FAX : 03-3570-0494 E-mail: 1. PSA 2 3 1 2 5 30 40

7 Zelefsky MJ, et al. 23: 826-831, 2005/ Stephenson AJ, et al. Curr. Treat. Options Oncol 5: 357-365, 2004 15 79 32 7 28 18 0 19 10 9 LDR-BT and HDR-BT 10 LDR-BT Grade3 Beyer DC, et al. Semin Radiat Oncol 13: 158-165, 2003/ Grado GL, et al. Urology 53:2-10, 1999 HDR-BT HDR-BT UCSF 1 18Gy/3 1 2 36 Gy Brain Lee, et al.

8 Int. J. Radiat. Oncol. Biol. Phys. 67: 1106-1112, 2007/BJ Trock, et al. JAMA299 (23): 2760-2769, 2008 Tharp 7 HDR-BT 58 (27 63 ) HDR-BT (6Gy 2) 2 (9Gy 1) 2 EBRT 7 5 PSA 2-3 M Tharp, et al. Brachytherapy 7: 231-236, 2008 2006 1 22Gy/2 / HDR-BT 1 2 MRI 3 MRI 4 10 1 6 bNED HDR-BT 1 227 9 791-794, 2008 EBRT HDR-BT D Amico AV.

9 1 PSA PSA (D Amico AV. Et al. Urology 54: 201-203, 1999) Male lumpectomy Focal therapy Whole gland therapy Onik Cryoablation 55 25 1 55 PSA failure free 95 Focal treatment (Gary Onik, et al. Urology 70: 16-21, 2007) Focal therapy 10 Focal therapy secondary tumor Focal therapy Rouviere MRI Biopsy PSA 22 2 MRI CE-Dyn MRI T2W-MRI biopsy findings CE-Dyn MRI (Olivier Rouviere, et al.)

10 Urology 63; 922-927, 2004) PSA I/II 2. CT,MRI Focal salvage HDR-BT 2006 22Gy/2 / UMIN ID : UMIN000006734 3. Phoenix PSA 6 rT1c-2bN0M0 12 * * 22 Gleason score PSA <10ng/ml MRI rT1c T2b T2a-2b *TNM UICC 2007 2010 411 72 2 730 CT cT1c-3aN0M0 iPSA 20ng/ml Gleason score iPSA