Goldner Gregor, Wachter Stefan, Wachter-Gerstner Natascha, Dieckmann Karin, Pötter Richard
Department of Radiotherapy and Radiobiology, University Hospital of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Strahlenther Onkol. 2006 Sep;182(9):537-42. doi: 10.1007/s00066-006-1607-8.
Biochemical control (bNED), disease-specific survival (DSS), overall survival (OS), and late gastrointestinal (GI) and urogenital (UG) side effects (EORTC/RTOG) of patients with long-term follow-up were evaluated.
Three-dimensional radiotherapy up to 66 Gy with/without additional hormonal therapy was performed in 154 prostate cancer (T1-3 N0 M0) patients. According to T-stage, pretreatment prostate-specific antigen (PSA) and grading, patients were divided into a low-, intermediate-, and high-risk group. The 5-, 8-, and 10-year actuarial rates of bNED, DSS and OS and late side effects were calculated.
Median follow-up was 80 months. Additional hormonal therapy was given in 57% of patients. Distribution concerning risk groups (low, intermediate, high) showed 15%, 49%, and 36% of patients, respectively. bNED 5-, 8-, and 10-year actuarial rates were 46%, 44%, and 44%. DSS 5-, 8- and 10-year rates amounted to 96%, 90%, and 82%. OS 5-, 8- and 10-year rates were 81%, 64%, and 56%. In uni- and multivariate analysis, only pretreatment PSA (<10 vs. >or=10 ng/ml; p<0.05) and PSA nadir (<0.5 vs. >or=0.5 ng/ml; p<0.0001) affected bNED significantly. Age, risk group, T-stage, grading, and hormonal therapy had no significant influence on bNED, DSS, and OS. Rates of late GI and UG side effects grade>or=2 at 5 years were 17% and 15%.
Current dose escalation studies with better bNED rates may be able to further increase long-term clinical outcome.
评估长期随访患者的生化控制（bNED）、疾病特异性生存（DSS）、总生存（OS）以及晚期胃肠道（GI）和泌尿生殖系统（UG）副作用（欧洲癌症研究与治疗组织/美国放射肿瘤学会标准）。
对154例前列腺癌（T1 - 3 N0 M0）患者进行了高达66 Gy的三维放疗，部分患者联合或不联合辅助激素治疗。根据T分期、治疗前前列腺特异性抗原（PSA）水平和分级，将患者分为低危、中危和高危组。计算bNED、DSS和OS的5年、8年和10年精算率以及晚期副作用发生率。
中位随访时间为80个月。57%的患者接受了辅助激素治疗。低危、中危和高危组患者的分布分别为15%、49%和36%。bNED的5年、8年和10年精算率分别为46%、44%和44%。DSS的5年、8年和10年率分别为96%、90%和82%。OS的5年、8年和10年率分别为81%、64%和56%。单因素和多因素分析显示，仅治疗前PSA（<10 vs. ≥10 ng/ml；p<0.05）和PSA最低点（<0.5 vs. ≥0.5 ng/ml；p<0.0001）对bNED有显著影响。年龄、风险组、T分期、分级和激素治疗对bNED、DSS和OS无显著影响。5年时晚期GI和UG副作用≥2级的发生率分别为17%和15%。
目前具有更好bNED率的剂量递增研究可能能够进一步改善长期临床结局。
