Schild S E, Buskirk S J, Robinow J S, Tomera K M, Ferrigni R G, Frick L M
Section of Radiation Oncology, Mayo Clinic Jacksonville, FL 32224.
Int J Radiat Oncol Biol Phys. 1992;23(1):141-5. doi: 10.1016/0360-3016(92)90553-t.
Eleven patients were initially treated for localized prostate cancer with radical retropubic prostatectomy following negative pelvic lymph node dissection. Six or more months after surgery, these patients had elevated serum prostate specific antigen (PSA) levels. No patient had other clinical evidence of disease as determined by history, physical examination, bone scan, computed tomographic scan of the abdomen and pelvis, chest radiograph, complete blood cell count, and serum chemistry profile. These patients received prostate bed irradiation using 10-MV photons and a four-field technique. Doses ranged from 60.0 to 65.8 Gy in 1.8 to 2.0 Gy fractions. Levels of serum PSA were monitored and decreased initially in all treated patients. In two patients, levels of PSA increased after this initial decrease. In 7 of the 11 patients (64%), PSA levels decreased to less than or equal to 0.3 ng/mL at last measurement. Radiotherapy resulted in no severe toxicity. None of the patients had developed clinical evidence of disease at the time of this report. Isolated elevations of serum PSA after prostatectomy reflect residual disease, and radiotherapy appears to effectively decrease the PSA levels in most cases. This effect appears to be accomplished by killing locally residual or recurrent cancer in the postoperative tumor bed.
11例患者最初接受了耻骨后根治性前列腺切除术治疗局限性前列腺癌，术前盆腔淋巴结清扫结果为阴性。术后6个月或更长时间，这些患者的血清前列腺特异性抗原（PSA）水平升高。根据病史、体格检查、骨扫描、腹部和盆腔计算机断层扫描、胸部X线片、全血细胞计数和血清化学检查，没有患者有其他疾病的临床证据。这些患者使用10兆伏光子和四野技术接受前列腺床照射。剂量范围为60.0至65.8 Gy，分1.8至2.0 Gy分次给予。监测所有治疗患者的血清PSA水平，最初均下降。2例患者PSA水平在最初下降后又升高。11例患者中有7例（64%）在最后一次测量时PSA水平降至小于或等于0.3 ng/mL。放射治疗未导致严重毒性。在本报告时，没有患者出现疾病的临床证据。前列腺切除术后血清PSA单独升高反映残留疾病，放射治疗在大多数情况下似乎能有效降低PSA水平。这种效果似乎是通过杀死术后肿瘤床局部残留或复发的癌细胞来实现的。
