King Christopher R, Spiotto Michael T
Department of Radiation Oncology, Division of Urologic Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA.
Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):23-7. doi: 10.1016/j.ijrobp.2007.09.047. Epub 2008 Jan 22.
To evaluate relapse-free survival with higher doses for patients receiving salvage radiotherapy (RT) after radical prostatectomy (RP).
A total of 122 patients with pathologically negative lymph nodes received salvage RT after RP from 1984 to 2004. Median prostate bed dose was 60 Gy for 38 patients and 70 Gy for 84 patients. Four months of total androgen suppression and whole-pelvic RT were given concurrently to 68 and 72 patients, respectively. The median follow-up was >5 years. Kaplan-Meier and Cox proportional hazards multivariable analyses were performed for all clinical, pathologic, and treatment factors predicting for biochemical relapse-free survival (bRFS).
There were 60 biochemical failures after salvage RT, with a median time to failure of 1.2 years. A dose response was observed, with a 5-year bRFS rate of 25% vs. 58% for prostate bed doses of 60 Gy vs. 70 Gy (p < 0.0001). For patients receiving RT alone the 5-year bRFS rate was 17% vs. 55% (p = 0.016), and for those receiving prostate-bed-only RT it was 23% vs. 66% (p = 0.037) for doses of 60 Gy vs. 70 Gy, respectively. On multivariate analysis a prostate bed dose of 70 Gy (p = 0.012, hazard ratio [HR] 0.48 [95% Confidence Interval (CI), 0.27-0.87]), pre-RT prostate-specific antigen value < or =1 ng/mL (p < 0.0001, HR 0.28 [95% CI, 0.16-0.48]), and lack of seminal vesicle involvement (p = 0.009, HR 0.44 [95% CI, 0.26-0.77]) remained independently significant.
A clinically significant dose response from 60 Gy to 70 Gy was observed in the setting of salvage RT after prostatectomy. A dose of 70 Gy to the prostate bed is recommended to achieve optimal disease-free survival.
评估根治性前列腺切除术后接受挽救性放疗（RT）的患者使用更高剂量放疗后的无复发生存率。
1984年至2004年间，共有122例病理检查淋巴结阴性的患者在根治性前列腺切除术后接受了挽救性放疗。38例患者前列腺床的中位放疗剂量为60 Gy，84例患者为70 Gy。分别有68例和72例患者在接受全盆腔放疗的同时进行了4个月的雄激素全阻断治疗。中位随访时间>5年。对所有预测生化无复发生存率（bRFS）的临床、病理和治疗因素进行了Kaplan-Meier分析和Cox比例风险多变量分析。
挽救性放疗后出现60例生化复发，复发的中位时间为1.2年。观察到剂量反应，前列腺床剂量为60 Gy与70 Gy时，5年bRFS率分别为25%和58%（p<0.0001）。对于仅接受放疗的患者，60 Gy与70 Gy剂量时的5年bRFS率分别为17%和55%（p=0.016）；对于仅接受前列腺床放疗的患者，相应的5年bRFS率分别为23%和66%（p=0.037）。多变量分析显示，前列腺床剂量70 Gy（p=0.012，风险比[HR]0.48[95%置信区间（CI），0.27 - 0.87]）、放疗前前列腺特异性抗原值≤1 ng/mL（p<0.0001，HR 0.28[95%CI，0.16 - 0.48]）以及无精囊受累（p=0.009，HR 0.44[95%CI，0.26 - 0.77]）仍然具有独立的显著性。
在前列腺切除术后挽救性放疗的情况下，观察到从60 Gy到70 Gy有显著的临床剂量反应。建议对前列腺床给予70 Gy的剂量以实现最佳的无病生存。
