Catton C, Gospodarowicz M, Warde P, Panzarella T, Catton P, McLean M, Milosevic M
Department of Radiation Oncology, The Princess Margaret Hospital and The University of Toronto, Ontario, Toronto, Canada.
Radiother Oncol. 2001 Apr;59(1):51-60. doi: 10.1016/s0167-8140(01)00302-4.
To evaluate the outcome of adjuvant and salvage radiotherapy (RT) after radical prostatectomy (RP) for clinically localized prostate cancer using conventional clinical end-points, and the biochemical relapse-free rate (bRFR).
Between 1987 and 1994, 113 node negative, hormonally naïve men received RT 1 month to 12 years after RP. Adjuvant RT was given for positive resection margins and/or pT3 disease. Salvage RT was given for a persistently elevated prostatic specific antigen (PSA), a rising PSA, or palpable recurrence post RP. Clinical and biochemical endpoints determined outcome. Log-rank testing and the Cox proportional hazards model identified factors predictive for biochemical relapse free rate.
Median follow-up after RT was 3.7 years (range 0.2-9 years). Five-year clinical local control was 95% for patients with no palpable evidence of disease and 59% for those with palpable recurrence (P < 0.0001). 5-year bRFR was 81% for adjuvant RT, 19% for salvage of biochemical recurrence, 0% for patients with palpable disease (P < 0.0001). Improved bRFR for adjuvant and salvage RT was predicted by a Gleason score < 7 vs. 7 vs. > 7 (hazard ratio 1.53; 95% CI 0.99-2.35) and an undetectable pre-RT PSA vs. PSA < 2.0 ng/ml vs. PSA > 2.0 ng/ml (hazard ratio 3.81; 95% CI 2.47-5.87). Seminal vesicle involvement was not a statistically significant independent predictor of bRFR.
The most favourable bRFR was observed for adjuvant therapy. Salvage was most successful with a pre-RT PSA < 2.0 ng/ml, or Gleason score < 7. Few patients with a pre-RT PSA > 2.0 ng/ml were salvaged, and none with palpable recurrence. These patients require investigation of alternative salvage strategies.
使用传统临床终点评估根治性前列腺切除术后对临床局限性前列腺癌进行辅助放疗和挽救性放疗的疗效，以及生化无复发生存率（bRFR）。
1987年至1994年间，113名淋巴结阴性、未接受过激素治疗的男性在前列腺癌根治术后1个月至12年接受了放疗。辅助放疗用于切缘阳性和/或pT3期疾病。挽救性放疗用于前列腺特异性抗原（PSA）持续升高、PSA上升或前列腺癌根治术后可触及复发的情况。临床和生化终点决定疗效。对数秩检验和Cox比例风险模型确定了预测生化无复发生存率的因素。
放疗后的中位随访时间为3.7年（范围0.2 - 9年）。对于无明显疾病证据的患者，5年临床局部控制率为95%，对于有可触及复发的患者为59%（P < 0.0001）。辅助放疗的5年bRFR为81%，生化复发挽救性放疗为19%，有可触及疾病的患者为0%（P < 0.0001）。Gleason评分<7与7与>7相比（风险比1.53；95%置信区间为0.99 - 2.35）以及放疗前PSA不可检测与PSA < 2.0 ng/ml与PSA > > 2.0 ng/ml相比（风险比3.81；95%置信区间为2.47 - 5.87）预测辅助放疗和挽救性放疗的bRFR会提高。精囊受累不是bRFR的统计学显著独立预测因素。
辅助治疗观察到最有利 的bRFR。放疗前PSA < 2.0 ng/ml或Gleason评分<7时，挽救性放疗最成功。放疗前PSA > 2.0 ng/ml的患者很少能挽救成功，有可触及复发的患者无一挽救成功。这些患者需要研究替代的挽救策略。
