De Meerleer Gert, Fonteyne Valérie, Meersschout Sabine, Van den Broecke Caroline, Villeirs Geert, Lumen Nicolaas, Ost Piet, Vandecasteele Katrien, De Neve Wilfried
Department of Radiation Oncology, Ghent University Hospital, Belgium.
Radiother Oncol. 2008 Nov;89(2):205-13. doi: 10.1016/j.radonc.2008.07.027. Epub 2008 Sep 2.
The aim was to prospectively evaluate both acute and late toxicity and biochemical non-evidence of disease (bNED) in patients treated with salvage intensity-modulated radiotherapy (IMRT) +/- androgen deprivation (AD) for biochemical relapse after radical prostatectomy (RP).
IMRT was prescribed to a mean prescription dose to the planning target volume (PTV) of 75 Gy to be delivered in 37 fractions of 2 Gy. In total, 135 patients were treated with IMRT. Median age was 64 years. Median PSA level was 0.8 ng/ml. AD was initiated in 94 patients. Indications were perineural invasion, seminal vesicle invasion or Gleason score > or = 8 at RP. (1) Acute toxicity (n = 135). All patients were available for this analysis. Acute toxicity was scored using an in-house developed scoring system. (2) Late toxicity (n = 68). Only patients with a follow-up of at least 18 months were considered for late toxicity analysis. The RILIT score was used to register gastro-intestinal (GI) toxicity. An in-house developed scale was used to register genito-urinary (GU) toxicity. (3) bNED (n = 87). For bNED, all AD-naive patients (n = 38) together with the AD-positive patients with a follow-up > or = 18 months (n = 49) were considered. Factors influencing the results of salvage treatment were analyzed.
(1) Acute toxicity (n = 135). No patient developed grade 3 GI toxicity. We observed grade 2 toxicity in 20 patients. Four patients developed grade 3 GU toxicity. (2) Late toxicity (n = 68). One patient developed grade 3 rectal blood loss. One patient developed grade 3 anal pain (anal fissure). We observed grade 2 GI toxicity in 9 patients. Two patients developed grade 3GU toxicity. Twenty-one patients developed grade 2 GU toxicity. We observed an urethral stricture in 5 patients. (3) bNED (n = 87). The 3- and 5-year bNED was 67%. Gleason score at RP, perineural invasion and capsular perforation were significant predictors for bNED. PSA before IMRT (<1.0 vs. 1.0 ng/ml) showed a trend in predicting bNED (p = 0.08).
IMRT to 75Gy+/-AD can be delivered with low levels of acute and late toxicity. In patients without perineural invasion and capsular invasion and with a Gleason score > or = 7 (3 + 4), IMRT offers very good 5-years bNED.
目的是前瞻性评估接受挽救性调强放射治疗（IMRT）±雄激素剥夺（AD）治疗的根治性前列腺切除术（RP）后生化复发患者的急性和晚期毒性以及疾病生化无证据（bNED）情况。
IMRT的计划靶体积（PTV）平均处方剂量为75Gy，分37次给予，每次2Gy。共有135例患者接受了IMRT治疗。中位年龄为64岁。中位前列腺特异性抗原（PSA）水平为0.8ng/ml。94例患者开始接受AD治疗。指征为RP时存在神经周围侵犯、精囊侵犯或Gleason评分≥8。（1）急性毒性（n = 135）。所有患者均纳入该分析。使用内部开发的评分系统对急性毒性进行评分。（2）晚期毒性（n = 68）。仅对随访至少18个月的患者进行晚期毒性分析。使用RILIT评分记录胃肠道（GI）毒性。使用内部开发的量表记录泌尿生殖系统（GU）毒性。（3）bNED（n = 87）。对于bNED，纳入所有未接受AD治疗的患者（n = 38）以及随访≥18个月的接受AD治疗的患者（n = 49）。分析影响挽救性治疗结果的因素。
（1）急性毒性（n = 135）。无患者发生3级GI毒性。20例患者出现2级毒性。4例患者发生3级GU毒性。（2）晚期毒性（n = 68）。1例患者出现3级直肠出血。1例患者出现3级肛门疼痛（肛裂）。9例患者出现2级GI毒性。2例患者发生3级GU毒性。21例患者出现2级GU毒性。5例患者出现尿道狭窄。（3）bNED（n = 87）。3年和5年bNED率为67%。RP时的Gleason评分、神经周围侵犯和包膜穿孔是bNED的显著预测因素。IMRT前的PSA（<1.0 vs. 1.0ng/ml）在预测bNED方面显示出趋势（p = 0.08）。
75Gy±AD的IMRT可以在低水平的急性和晚期毒性下进行。对于没有神经周围侵犯和包膜侵犯且Gleason评分≥7（3 + 4）的患者，IMRT提供了非常好的5年bNED率。
