Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):e233-8. doi: 10.1016/j.ijrobp.2011.04.003. Epub 2011 May 24.
Despite results of randomized trials that support adjuvant radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer with adverse pathologic features (APF), many clinicians favor selective use of salvage RT. This survey was conducted to evaluate the beliefs and practices of radiation oncologists (RO) and urologists (U) regarding RT after RP.
We designed a Web-based survey of post-RP RT beliefs and policies. Survey invitations were e-mailed to a list of 926 RO and 591 U. APF were defined as extracapsular extension, seminal vesicle invasion, or positive surgical margin. Differences between U and RO in adjuvant RT recommendations were evaluated by comparative statistics. Multivariate analyses were performed to evaluate factors predictive of adjuvant RT recommendation.
Analyzable surveys were completed by 218 RO and 92 U (overallresponse rate, 20%). Adjuvant RT was recommended based on APF by 68% of respondents (78% RO, 44% U, p <0.001). U were less likely than RO to agree that adjuvant RT improves survival and/or biochemical control (p < 0.0001). PSA thresholds for salvage RT were higher among U than RO (p < 0.001). Predicted rates of erectile dysfunction due to RT were higher among U than RO (p <0.001). On multivariate analysis, respondent specialty was the only predictor of adjuvant RT recommendations.
U are less likely than RO to recommend adjuvant RT. Future research efforts should focus on defining the toxicities of post-RP RT and on identifying the subgroups of patients who will benefit from adjuvant vs. selective salvage RT.
尽管随机试验结果支持对具有不良病理特征（APF）的前列腺癌行根治性前列腺切除术（RP）后行辅助放疗（RT），但许多临床医生更倾向于选择性使用挽救性 RT。本调查旨在评估放射肿瘤学家（RO）和泌尿科医生（U）对 RP 后 RT 的信念和实践。
我们设计了一项基于网络的关于 RP 后 RT 信念和政策的调查。向 926 名 RO 和 591 名 U 的电子邮件列表发送了调查邀请。APF 定义为包膜外延伸、精囊侵犯或阳性手术切缘。通过比较统计评估 U 和 RO 在辅助 RT 推荐方面的差异。进行多变量分析以评估预测辅助 RT 推荐的因素。
218 名 RO 和 92 名 U 完成了可分析的调查（总体应答率为 20%）。68%的受访者（78%为 RO，44%为 U）根据 APF 推荐辅助 RT。U 比 RO 更不可能同意辅助 RT 可改善生存和/或生化控制（p<0.0001）。U 比 RO 更有可能认为挽救性 RT 的 PSA 阈值更高（p<0.001）。U 比 RO 更有可能认为 RT 导致勃起功能障碍的预测发生率更高（p<0.001）。多变量分析显示，受访者的专业是辅助 RT 推荐的唯一预测因素。
U 比 RO 更不可能推荐辅助 RT。未来的研究工作应集中在定义 RP 后 RT 的毒性，并确定将从辅助 RT 与选择性挽救性 RT 中获益的患者亚组。
