Vicini F A, Ziaja E L, Kestin L L, Brabbins D S, Stromberg J S, Gonzalez J A, Martinez A A
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Urology. 1999 Jul;54(1):111-7. doi: 10.1016/s0090-4295(99)00219-8.
To determine the factors associated with outcome by reviewing our institution's experience treating patients with external beam radiation therapy (RT) after radical prostatectomy.
Sixty-one patients received RT to the prostatic fossa after radical prostatectomy for prostate cancer (median dose 59.4 Gy). Thirty-eight patients received adjuvant RT within 6 months of surgery for adverse pathologic findings only. Therapeutic RT was administered to 23 patients either for a persistently elevated postoperative prostate-specific antigen (PSA) level (n = 2), a rising PSA level more than 6 months after surgery (n = 9), or a biopsy-proven local recurrence (n = 12). Preoperative and preradiation PSA values, Gleason score, pathologic findings, patient age, total RT dose, and indication for RT were analyzed for their impact on biochemical control. The median follow-up was 48 months.
Patients treated with adjuvant RT achieved 3 and 5-year biochemical control rates of 84% and 67%, respectively. Multiple clinical, pathologic, and treatment-related factors were analyzed for an association with biochemical control. No variable was associated with 5-year outcome. The 5-year actuarial rate of biochemical control for patients treated with therapeutic RT was 16%. Multiple clinical, pathologic, and treatment-related factors were analyzed for an association with biochemical control. Only a pre-RT PSA level of 2 ng/mL or less was associated with an improved rate of biochemical control at 3 years (80% versus 27%, P = 0.001). However, at 5 years, this difference was not statistically significant. A separate analysis was performed to determine the prognostic factors associated with outcome for the entire group of patients. Only the indication for RT (adjuvant versus therapeutic) was associated with 5-year outcome. Patients treated with adjuvant RT had a statistically significant improvement in 5-year actuarial rates of biochemical control (67% versus 16%, P <0.001) and disease-free survival (66% versus 46%, P = 0.037) but not in overall survival. There were no statistically significant differences between patient groups with respect to age, preoperative PSA, Gleason score, pathologic T stage, median follow-up, and total RT dose.
At our institution, patients treated with adjuvant RT after prostatectomy for adverse pathologic findings achieved excellent rates of biochemical control that were significantly better than that of similar patients treated therapeutically for persistent or rising PSA or clinical local recurrence.
通过回顾我院对前列腺癌根治术后患者进行外照射放疗（RT）的经验，确定与治疗结果相关的因素。
61例患者在前列腺癌根治术后接受前列腺窝放疗（中位剂量59.4 Gy）。38例患者仅因不良病理结果在术后6个月内接受辅助放疗。23例患者接受治疗性放疗，原因包括术后前列腺特异性抗原（PSA）水平持续升高（n = 2）、术后6个月以上PSA水平升高（n = 9）或活检证实的局部复发（n = 12）。分析术前和放疗前PSA值、Gleason评分、病理结果、患者年龄、总放疗剂量以及放疗指征对生化控制的影响。中位随访时间为48个月。
接受辅助放疗的患者3年和5年生化控制率分别为84%和67%。分析了多种临床、病理和治疗相关因素与生化控制的相关性。没有变量与5年治疗结果相关。接受治疗性放疗的患者5年生化控制精算率为16%。分析了多种临床、病理和治疗相关因素与生化控制的相关性。仅放疗前PSA水平≤2 ng/mL与3年生化控制率提高相关（80%对27%，P = 0.001）。然而，在5年时，这种差异无统计学意义。进行了一项单独分析以确定整个患者组与治疗结果相关的预后因素。仅放疗指征（辅助放疗与治疗性放疗）与5年治疗结果相关。接受辅助放疗患者的5年生化控制精算率（67%对16%，P <0.001）和无病生存率（66%对46%，P = 0.037）有统计学显著改善，但总生存率无改善。患者组在年龄、术前PSA、Gleason评分、病理T分期、中位随访时间和总放疗剂量方面无统计学显著差异。
在我院，因不良病理结果在前列腺癌根治术后接受辅助放疗的患者生化控制率极佳，明显优于因PSA持续或升高或临床局部复发接受治疗性放疗的类似患者。
