Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy.
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):e721-6. doi: 10.1016/j.ijrobp.2010.12.003. Epub 2011 Jan 27.
To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT).
Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score≥7 and/or prostate-specific antigen level≥20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%, and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT).
A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12-38). With a median follow-up of 52 months (range, 20-150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p=NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p=.03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p=NS).
Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.
评估接受放疗（RT）和长期（>1 年）雄激素剥夺治疗（ADT）的前列腺癌患者进行全盆腔放疗（WPRT）的效果。
本分析纳入了高风险特征（T3-T4 期和/或 Gleason 评分≥7 和/或前列腺特异性抗原水平≥20ng/ml）接受 RT 和长期 ADT 的前列腺癌患者。患有肠道炎性疾病、结肠憩室和结肠炎的患者被排除在 WPRT 之外，仅接受前列腺放疗（PORT）。根据 Roach 公式评估的淋巴结风险受累情况，将患者分为不同的截定点（15%、20%、25%和 30%）。根据 RT 类型（WPRT 或 PORT），分析每组的生化无病生存（bDFS）。
共纳入 1994 年至 2007 年间治疗的 358 例患者（46.9%接受 WPRT，53.1%接受 PORT）。ADT 的中位持续时间为 24 个月（范围 12-38）。中位随访 52 个月（范围 20-150），总体 4 年 bDFS 率为 90.5%。接受 WPRT 或 PORT 的患者 4 年 bDFS 率相似（90.4%与 90.5%；p=NS）。然而，在淋巴结风险最高的患者组（>30%），接受 WPRT 的患者 bDFS 显著改善（p=.03）。接受 WPRT 或 PORT 治疗的患者之间急性毒性无差异。PORT 或 WPRT 治疗的患者晚期胃肠道毒性相似（p=NS）。
我们的分析支持将 WPRT 与长期 ADT 联合用于高淋巴结风险（>30%）患者，尽管需要随机试验来证实这一明确建议。
