Cozzarini Cesare, Montorsi Francesco, Fiorino Claudio, Alongi Filippo, Bolognesi Angelo, Da Pozzo Luigi Filippo, Guazzoni Giorgio, Freschi Massimo, Roscigno Marco, Scattoni Vincenzo, Rigatti Patrizio, Di Muzio Nadia
Department of Radiotherapy, Scientific Institute Hospital San Raffaele, Milan, Italy.
Int J Radiat Oncol Biol Phys. 2009 Nov 15;75(4):966-74. doi: 10.1016/j.ijrobp.2008.12.059. Epub 2009 Jul 18.
To determine the clinical benefit of high-dose early adjuvant radiotherapy (EART) in high-risk prostate cancer (hrCaP) patients submitted to radical retropubic prostatectomy plus pelvic lymphadenectomy.
The clinical outcome of 334 hrCaP (pT3-4 and/or positive resection margins) node-negative patients submitted to radical retropubic prostatectomy plus pelvic lymphadenectomy before 2004 was analyzed according to the EART dose delivered to the prostatic bed, <70.2 Gy (lower dose, median 66.6 Gy, n = 153) or >or=70.2 Gy (median 70.2 Gy, n = 181).
The two groups were comparable except for a significant difference in terms of median follow-up (10 vs. 7 years, respectively) owing to the gradual increase of EART doses over time. Nevertheless, median time to prostate-specific antigen (PSA) failure was almost identical, 38 and 36 months, respectively. At univariate analysis, both 5-year biochemical relapse-free survival (bRFS) and disease-free survival (DFS) were significantly higher (83% vs. 71% [p = 0.001] and 94% vs. 88% [p = 0.005], respectively) in the HD group. Multivariate analysis confirmed EART dose >or=70 Gy to be independently related to both bRFS (hazard ratio 2.5, p = 0.04) and DFS (hazard ratio 3.6, p = 0.004). Similar results were obtained after the exclusion of patients receiving any androgen deprivation. After grouping the hormone-naïve patients by postoperative PSA level the statistically significant impact of high-dose EART on both 5-year bRFS and DFS was maintained only for those with undetectable values, possibly owing to micrometastatic disease outside the irradiated area in case of detectable postoperative PSA values.
This series provides strong support for the use of EART doses >or=70 Gy after radical retropubic prostatectomy in hrCaP patients with undetectable postoperative PSA levels.
确定接受根治性耻骨后前列腺切除术加盆腔淋巴结清扫术的高危前列腺癌（hrCaP）患者中，高剂量早期辅助放疗（EART）的临床获益。
分析2004年前接受根治性耻骨后前列腺切除术加盆腔淋巴结清扫术的334例hrCaP（pT3 - 4和/或手术切缘阳性）且淋巴结阴性患者的临床结局，根据前列腺床接受的EART剂量分为<70.2 Gy（低剂量组，中位剂量66.6 Gy，n = 153）或≥70.2 Gy（中位剂量70.2 Gy，n = 181）。
两组除中位随访时间有显著差异（分别为10年和7年）外具有可比性，这是由于EART剂量随时间逐渐增加。然而，前列腺特异性抗原（PSA）失败的中位时间几乎相同，分别为38个月和36个月。单因素分析显示，高剂量组的5年无生化复发生存率（bRFS）和无病生存率（DFS）均显著更高（分别为83%对71% [p = 0.001]和94%对88% [p = 0.005]）。多因素分析证实EART剂量≥70 Gy与bRFS（风险比2.5，p = 0.04）和DFS（风险比3.6，p = 0.004）均独立相关。排除接受任何雄激素剥夺治疗的患者后，得到了相似的结果。在将未接受激素治疗的患者按术后PSA水平分组后，高剂量EART对5年bRFS和DFS的统计学显著影响仅在术后PSA值不可检测的患者中得以维持，这可能是因为术后PSA值可检测时，在照射区域外存在微转移疾病。
本系列研究有力支持在术后PSA水平不可检测的hrCaP患者行根治性耻骨后前列腺切除术后使用≥70 Gy的EART剂量。
