Velasco J, Tekyi-Mensah S, Bolton S, Forman J D
Department of Radiation Oncology, Wayne State University School of Medicine, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
Urology. 1999 Aug;54(2):325-8. doi: 10.1016/s0090-4295(99)00123-5.
To determine whether the response to hormonal therapy before radiation predicts the rate of biochemical relapse in patients with locally advanced prostate cancer.
Between October 1991 and December 1997, 105 patients with locally advanced adenocarcinoma of the prostate received radiotherapy in two dose-escalation studies. Sixty-seven patients received neoadjuvant hormonal therapy. The mean and median duration of hormonal therapy before radiotherapy was 4 months each. All treatments were designed using three-dimensional conformal therapy. The total dose to the gross tumor volume ranged from 73 to 87 Gy in 2 Gy per fraction photon equivalent dose. The median follow-up time was 30 months (range 1 to 66).
The median prostate-specific antigen (PSA) nadir after neoadjuvant hormonal therapy but before radiotherapy was 1.7 ng/mL (range less than 0.05 to 71.2). The median nadir after radiation for patients who did and did not receive neoadjuvant androgen deprivation was 0.25 ng/mL (range less than 0.05 to 6.2) and 1.35 ng/mL (range 0.08 to 10), respectively. Median time to achieve nadir was 6 months (range 1 to 42) with and 12 months (range 1 to 48) without hormonal therapy. There was no significant difference in the rate of biochemical failure for patients with a posthormone (before irradiation) PSA nadir less than 1 ng/mL versus 1 ng/mL or greater (overall P = 0.9). However, there was a significant difference in biochemical no evidence of disease rates between those with a PSA nadir less than 1 ng/mL and those with a PSA nadir of 1 ng/mL or greater after radiation (63% versus 22% at 3 years, overall P <0.001).
Our data showed that the initial response to hormonal therapy before radiation, as indicated by the PSA level, did not impact on the rate of recurrence. However, the time to reach nadir and the absolute nadir level achieved were lower in patients who did receive hormonal therapy.
确定局部晚期前列腺癌患者放疗前对激素治疗的反应是否能预测生化复发率。
1991年10月至1997年12月期间，105例局部晚期前列腺腺癌患者在两项剂量递增研究中接受了放疗。67例患者接受了新辅助激素治疗。放疗前激素治疗的平均和中位持续时间均为4个月。所有治疗均采用三维适形治疗设计。大体肿瘤体积的总剂量在每分次2 Gy光子等效剂量下为73至87 Gy。中位随访时间为30个月（范围1至66个月）。
新辅助激素治疗后但放疗前前列腺特异性抗原（PSA）的中位最低点为1.7 ng/mL（范围小于0.05至71.2）。接受和未接受新辅助雄激素剥夺的患者放疗后的中位最低点分别为0.25 ng/mL（范围小于0.05至6.2）和1.35 ng/mL（范围0.08至10）。达到最低点的中位时间在接受激素治疗的患者中为6个月（范围1至42个月），未接受激素治疗的患者中为12个月（范围1至48个月）。激素治疗后（放疗前）PSA最低点小于1 ng/mL与1 ng/mL或更高的患者生化失败率无显著差异（总体P = 0.9）。然而，放疗后PSA最低点小于1 ng/mL的患者与PSA最低点为1 ng/mL或更高的患者之间生化无疾病证据率存在显著差异（3年时分别为63%和22%，总体P <0.001）。
我们的数据表明，放疗前激素治疗的初始反应（由PSA水平指示）对复发率没有影响。然而，接受激素治疗的患者达到最低点的时间和达到的绝对最低点水平较低。
