Pacholke Heather D, Wajsman Zev, Algood Chester B, Neulander Endre Z, Morris Christopher G, Zlotecki Robert A
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610, USA.
Urology. 2004 Nov;64(5):982-6. doi: 10.1016/j.urology.2004.06.020.
To determine the therapeutic outcomes in patients with high-risk prostate cancer treated with adjuvant or salvage radiotherapy (RT) after radical prostatectomy.
Between 1982 and 2000, 163 patients were treated with RT after radical prostatectomy. Adjuvant therapy was administered to 107 consecutive node-negative patients (T2-T4N0) referred to our institution less than 1 year after surgery for postoperative RT. Salvage treatment was delivered to 56 patients for a persistently elevated prostate-specific antigen level, biochemical relapse after surgery, or local recurrence.
The median follow-up was 70 months (range 2 to 167) from the initiation of RT. Patients treated with adjuvant RT were less likely than those treated with salvage RT to experience biochemical relapse. At 5 and 10 years, the rate of freedom from biochemical relapse was 80% and 66% in the adjuvant cohort compared with 39% and 22% for patients treated with salvage intent, respectively (P <0.0001). This did not translate into a statistically significant improvement in absolute survival (72% versus 70%) or cause-specific survival (93% versus 86%) at 10 years. On multivariate analysis, neoadjuvant hormonal therapy (P = 0.0187), presence of seminal vesicle involvement (P = 0.0002), and referral indication for postoperative RT (salvage versus adjuvant RT; P <0.001) were predictors of biochemical relapse.
In this single-institution experience, patients at high risk of disease recurrence after radical prostatectomy realized a greater biochemical relapse-free survival benefit when treated with adjuvant RT than with salvage RT. Neoadjuvant hormonal therapy and seminal vesicle involvement predicted for inferior treatment outcome.
确定根治性前列腺切除术后接受辅助性或挽救性放疗（RT）的高危前列腺癌患者的治疗效果。
1982年至2000年间，163例患者在根治性前列腺切除术后接受了放疗。对107例连续的淋巴结阴性患者（T2-T4N0）进行辅助治疗，这些患者在术后不到1年因术后放疗转诊至我院。对56例患者进行挽救性治疗，原因是前列腺特异性抗原水平持续升高、术后生化复发或局部复发。
从放疗开始的中位随访时间为70个月（范围2至167个月）。接受辅助性放疗的患者比接受挽救性放疗的患者发生生化复发的可能性更小。在5年和10年时，辅助治疗队列中无生化复发率分别为80%和66%，而接受挽救性治疗的患者分别为39%和22%（P<0.0001）。这在10年时并未转化为绝对生存率（72%对70%）或病因特异性生存率（93%对86%）的统计学显著改善。多因素分析显示，新辅助激素治疗（P=0.0187）、精囊受累情况（P=0.0002）以及术后放疗的转诊指征（挽救性放疗与辅助性放疗；P<0.001）是生化复发的预测因素。
在本单中心经验中，根治性前列腺切除术后疾病复发风险高的患者接受辅助性放疗比接受挽救性放疗能获得更大的无生化复发生存获益。新辅助激素治疗和精囊受累预示治疗效果较差。
