Jereczek-Fossa Barbara A, Zerini Dario, Vavassori Andrea, Fodor Cristiana, Santoro Luigi, Minissale Antonio, Cambria Raffaella, Cattani Federica, Garibaldi Cristina, Serafini Flavia, Matei Victor Deliu, de Cobelli Ottavio, Orecchia Roberto
Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
Int J Radiat Oncol Biol Phys. 2009 May 1;74(1):115-25. doi: 10.1016/j.ijrobp.2008.07.057. Epub 2008 Nov 12.
To evaluate the outcome of postoperative radiotherapy (PORT) and salvage RT (SART) using a three-dimensional conformal two-dynamic arc (3D-ART) or 3D six-field technique in 431 prostate cancer patients.
Of the 431 patients, 258 underwent PORT (started <6 months after radical prostatectomy) and 173 underwent SART because of biochemical failure after radical prostatectomy. The median patient age, preoperative prostate-specific antigen level, and Gleason score was 66 years, 9.4 ng/mL, and 7, respectively. The median radiation dose was 70 Gy in 35 fractions for both PORT and SART. The 3D six-field and 3D-ART techniques were used in 25.1% and 74.9% of patients, respectively. Biochemical failure was defined as a post-RT prostate-specific antigen nadir plus 0.1 ng/mL.
Acute toxicity included rectal events (PORT, 44.2% and 0.8% Grade 1-2 and Grade 3, respectively; SART, 42.2% and 1.2% Grade 1-2 and Grade 3, respectively) and urinary events (PORT, 51.2% and 2.3% Grade 1-2 and Grade 3-4, respectively; SART, 37.6% and 0% Grade 1-2 and Grade 3, respectively). Late toxicity also included rectal events (PORT, 14.7% and 0.8% Grade 1-2 and Grade 3-4, respectively; SART, 15.0% and 0.6% Grade 1-2 and Grade 3, respectively) and urinary events (PORT, 28.3% and 3.7% Grade 1-2 and Grade 3-4, respectively; SART, 19.3% and 0.6% Grade 1-2 and Grade 3, respectively). After a median follow-up of 48 months, failure-free survival, including biochemical and clinical failure, was significantly longer in the PORT patients (79.8% vs. 60.5%, p < 0.0001). Multivariate analysis showed that a prostate-specific antigen level postoperatively but before RT of >/=0.2 ng/mL (p < 0.001), Gleason score >6 (p = 0.025) and use of preoperative androgen deprivation (p = 0.002) correlated significantly with shorter failure-free survival. Multivariate analysis showed that PORT and the 3D-ART technique correlated with greater late urinary toxicity.
PORT and early referral for SART offer better disease control after radical prostatectomy. The greater urinary toxicity occurring after PORT and 3D-ART requires further investigation to improve the therapeutic index.
评估431例前列腺癌患者采用三维适形双动态弧（3D - ART）或三维六野技术进行术后放疗（PORT）和挽救性放疗（SART）的结果。
431例患者中，258例行PORT（前列腺癌根治术后<6个月开始），173例因前列腺癌根治术后生化复发而行SART。患者中位年龄、术前前列腺特异性抗原水平和Gleason评分分别为66岁、9.4 ng/mL和7分。PORT和SART的中位放疗剂量均为70 Gy，分35次。分别有25.1%和74.9%的患者采用三维六野和3D - ART技术。生化复发定义为放疗后前列腺特异性抗原最低点加0.1 ng/mL。
急性毒性反应包括直肠反应（PORT组1 - 2级和3级分别为44.2%和0.8%；SART组1 - 2级和3级分别为42.2%和1.2%）和泌尿反应（PORT组1 - 2级和3 - 4级分别为51.2%和2.3%；SART组1 - 2级和3级分别为37.6%和0%）。晚期毒性反应也包括直肠反应（PORT组1 - 2级和3 - 4级分别为14.7%和0.8%；SART组1 - 2级和3级分别为15.0%和0.6%）和泌尿反应（PORT组1 - 2级和3 - 4级分别为28.3%和3.7%；SART组1 - 2级和3级分别为19.3%和0.6%）。中位随访48个月后，PORT组患者无失败生存（包括生化和临床复发）显著更长（79.8%对60.5%，p< .0001）。多因素分析显示，放疗前术后前列腺特异性抗原水平≥0.2 ng/mL（p< .001）、Gleason评分>6（p = 0.025）以及术前使用雄激素剥夺治疗（p = 0.002）与无失败生存时间缩短显著相关。多因素分析显示，PORT和3D - ART技术与更高的晚期泌尿毒性相关。
PORT和早期转诊进行SART在前列腺癌根治术后能提供更好的疾病控制。PORT和3D - ART后出现的更大泌尿毒性需要进一步研究以提高治疗指数。
