Kuban Deborah A, Thames Howard D, Levy Larry B, Horwitz Eric M, Kupelian Patrick A, Martinez Alvaro A, Michalski Jeff M, Pisansky Thomas M, Sandler Howard M, Shipley William U, Zelefsky Michael J, Zietman Anthony L
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 2003 Nov 15;57(4):915-28. doi: 10.1016/s0360-3016(03)00632-1.
To report the long-term outcome for patients with Stage T1-T2 adenocarcinoma of the prostate definitively irradiated in the prostate-specific antigen (PSA) era.
Nine institutions combined data on 4839 patients with Stage T1b, T1c, and T2 adenocarcinoma of the prostate who had a pretreatment PSA level and had received >or=60 Gy as definitive external beam radiotherapy. No patient had hormonal therapy before treatment failure. The median follow-up was 6.3 years. The end point for outcome analysis was PSA disease-free survival at 5 and 8 years after therapy using the American Society for Therapeutic Radiology and Oncology (ASTRO) failure definition.
The PSA disease-free survival rate for the entire group of patients was 59% at 5 years and 53% at 8 years after treatment. For patients who had received >or=70 Gy, these percentages were 61% and 55%. Of the 4839 patients, 1582 had failure by the PSA criteria, 416 had local failure, and 329 had distant failure. The greatest risk of failure was at 1.5-3.5 years after treatment. The failure rate was 3.5-4.5% annually after 5 years, except in patients with Gleason score 8-10 tumors for whom it was 6%. In multivariate analysis for biochemical failure, pretreatment PSA, Gleason score, radiation dose, tumor stage, and treatment year were all significant prognostic factors. The length of follow-up and the effect of backdating as required by the ASTRO failure definition also significantly affected the outcome results. Dose effects were most significant in the intermediate-risk group and to a lesser degree in the high-risk group. No dose effect was seen at 70 or 72 Gy in the low-risk group.
As follow-up lengthens and outcome data accumulate in the PSA era, we continue to evaluate the efficacy and durability of radiotherapy as definitive therapy for early-stage prostate cancer. Similar studies with higher doses and more contemporary techniques will be necessary to explore more fully the potential of this therapeutic modality.
报告在前列腺特异性抗原（PSA）时代接受前列腺根治性放疗的T1 - T2期前列腺腺癌患者的长期预后。
9家机构汇总了4839例T1b、T1c和T2期前列腺腺癌患者的数据，这些患者治疗前有PSA水平，且接受了≥60 Gy的根治性外照射放疗。治疗失败前无患者接受过激素治疗。中位随访时间为6.3年。结局分析的终点是根据美国放射肿瘤学会（ASTRO）失败定义，治疗后5年和8年的PSA无病生存率。
整个患者组治疗后5年的PSA无病生存率为59%，8年为53%。接受≥70 Gy照射的患者，这两个百分比分别为61%和55%。4839例患者中，1582例根据PSA标准出现失败，416例出现局部失败，329例出现远处失败。失败风险最高的时间是治疗后1.5 - 3.5年。5年后每年的失败率为3.5 - 4.5%，但Gleason评分8 - 10分肿瘤的患者失败率为6%。在生化失败的多因素分析中，治疗前PSA、Gleason评分、放射剂量、肿瘤分期和治疗年份均为显著的预后因素。随访时间长度以及ASTRO失败定义要求的回溯效应也显著影响结局结果。剂量效应在中危组最为显著，在高危组程度较轻。低危组在70或72 Gy时未观察到剂量效应。
随着PSA时代随访时间的延长和结局数据的积累，我们继续评估放疗作为早期前列腺癌根治性治疗的疗效和持久性。需要进行更高剂量和更现代技术的类似研究，以更充分地探索这种治疗方式的潜力。
