接受三联疗法治疗的局部晚期前列腺癌患者的肿瘤控制结果。

Tumor control outcomes of patients treated with trimodality therapy for locally advanced prostate cancer.

作者信息

Copp Hillary, Bissonette Eric A, Theodorescu Dan

机构信息

Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.

出版信息

Urology. 2005 Jun;65(6):1146-51. doi: 10.1016/j.urology.2004.12.014.

DOI:10.1016/j.urology.2004.12.014

PMID:15922433

Abstract

OBJECTIVES

To evaluate, in a pilot study, the tumor control outcomes of our approach and define the pretreatment characteristics that predict a response to therapy. Patients with advanced clinically localized prostate cancer have a high likelihood of prostate-specific antigen (PSA) failure 3 to 5 years after initial treatment. We adopted trimodality therapy (neoadjuvant and adjuvant androgen ablation, external beam radiotherapy [RT], and a brachytherapy boost) to augment biochemical disease-free survival in this patient population.

METHODS

From 1997 to 2000, 93 patients with clinical Stage T2b or greater, or PSA level greater than 10 ng/mL, or Gleason score 7 or greater were treated with external beam RT followed by palladium-103 brachytherapy. Two to three months before external beam RT, an 8 to 9-month regimen of leuprolide and an oral antiandrogen was initiated. Patients were followed up at 3 to 4-month intervals with PSA determination and digital rectal examination. Perineural invasion, the percentage of cancer in biopsy cores, pretreatment PSA level, clinical T stage, and Gleason score were analyzed as prognostic factors for biochemical failure defined by both the American Society for Therapeutic Radiology and Oncology (ASTRO) criteria and PSA level greater than 0.2 ng/mL.

RESULTS

The median length of follow-up was 45 months. The overall probability of biochemical failure using a PSA level greater than 0.2 ng/mL at 4 years was 79% (95% confidence interval 69% to 89%). With the ASTRO criteria, the overall failure rate at the same point was 77% (95% confidence interval 68% to 87%). Gleason score (P = 0.07) showed a trend toward predicting biochemical failure using the PSA level greater than 0.2 ng/mL criterion.

CONCLUSIONS

Trimodality RT offers excellent tumor control in patients with poor prognosis who often relapse early. Longer follow-up will be important to determine whether these results are durable over time.

摘要

目的

在一项初步研究中评估我们的治疗方法的肿瘤控制效果，并确定预测治疗反应的治疗前特征。晚期临床局限性前列腺癌患者在初始治疗后3至5年发生前列腺特异性抗原（PSA）失败的可能性很高。我们采用三联疗法（新辅助和辅助雄激素剥夺、外照射放疗[RT]以及近距离放疗强化）来提高该患者群体的无生化疾病生存率。

方法

1997年至2000年，93例临床分期为T2b或更高、或PSA水平大于10 ng/mL、或Gleason评分7或更高的患者接受了外照射放疗，随后进行钯-103近距离放疗。在外照射放疗前两到三个月，开始使用亮丙瑞林和口服抗雄激素药物进行为期8至9个月的治疗方案。患者每隔3至4个月进行随访，测定PSA并进行直肠指检。分析神经周围浸润、活检组织芯中癌的百分比、治疗前PSA水平、临床T分期和Gleason评分，将其作为根据美国放射肿瘤学会（ASTRO）标准和PSA水平大于0.2 ng/mL定义的生化失败的预后因素。

结果

中位随访时间为45个月。4年时PSA水平大于0.2 ng/mL的生化失败总体概率为79%（95%置信区间69%至89%）。根据ASTRO标准，同一时间点的总体失败率为77%（95%置信区间68%至87%）。Gleason评分（P = 0.07）在使用PSA水平大于0.2 ng/mL标准预测生化失败方面呈趋势。