Symon Zvi, Griffith Kent A, McLaughlin P William, Sullivan Molly, Sandler Howard M
Department of Radiation Oncology, University of Michigan, Ann Arbor 48109-0010, USA.
Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):384-90. doi: 10.1016/s0360-3016(03)00569-8.
To determine the effect of radiation dose escalation on biochemical and/or disease failure in patients with localized prostate cancer treated with three-dimensional conformal radiotherapy (3D-CRT).
Between May 1987 and December 2000, 1473 patients were assessed after treatment with 3D-CRT. The mean patient age was 70.4 +/- 6.8 years, 1316 patients had T1-T2 disease, and 1150 had Gleason score <or=7. The median pretreatment prostate-specific antigen (PSA) level was 8.9 ng/mL. The mean dose was 71.7 +/- 4.3 Gy (range 60.0-80.4). Failure was defined as the first event of any of the following: biochemical failure, local recurrence or metastasis, postirradiation hormonal therapy, or death from disease.
At a median follow-up of 35.2 months, 395 failures (26.8%) had occurred. Adjusting for dose as a continuous variable, the hazard ratio for failure was 2.03 (p < 0.0001) for 569 intermediate-risk patients (stage T1-T2 and Gleason score 7 or PSA 10-20 ng/mL) and 5.16 (p < 0.0001) for 456 high-risk patients (stage T3-T4 or PSA >20 ng/mL or Gleason score >or=8) compared with 448 low-risk patients (stage T1-T2 and Gleason score <or=6 and PSA <10 ng/mL). For intermediate-risk patients, each 1-Gy increment in total radiation dose was associated with a highly significant 8% reduction in the probability of failure (hazard ratio = 0.92, p = 0.005).
Dose escalation using 3D-CRT significantly reduces the risk of biochemical/disease failure among intermediate-risk prostate cancer patients.
确定三维适形放疗（3D-CRT）治疗局限性前列腺癌患者时，增加放射剂量对生化指标和/或疾病复发的影响。
1987年5月至2000年12月期间，对1473例接受3D-CRT治疗的患者进行了评估。患者平均年龄为70.4±6.8岁，1316例患者患有T1-T2期疾病，1150例患者的Gleason评分≤7。治疗前前列腺特异性抗原（PSA）水平的中位数为8.9 ng/mL。平均剂量为71.7±4.3 Gy（范围60.0-80.4）。疾病复发定义为以下任何一种首次事件：生化指标复发、局部复发或转移、放疗后激素治疗或死于该疾病。
中位随访35.2个月时，发生了395例复发（26.8%）。将剂量作为连续变量进行校正后，569例中危患者（T1-T2期且Gleason评分为7或PSA为10-20 ng/mL）的复发风险比为2.03（p<0.0001），456例高危患者（T3-T4期或PSA>20 ng/mL或Gleason评分≥8）的复发风险比为5.16（p<0.0001），而448例低危患者（T1-T2期且Gleason评分≤6且PSA<10 ng/mL）的复发风险比为1。对于中危患者，总放射剂量每增加1 Gy，复发概率显著降低8%（风险比=0.92，p=0.005）。
使用3D-CRT增加剂量可显著降低中危前列腺癌患者生化指标/疾病复发的风险。
