Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, WI 53792, USA.
Cancer. 2011 Jun 15;117(12):2629-36. doi: 10.1002/cncr.25824. Epub 2010 Dec 14.
Postprostatectomy adjuvant or salvage radiotherapy, when using standard fractionation, requires 6.5 to 8 weeks of treatment. The authors report on the safety and efficacy of an expedited radiotherapy course for salvage prostate radiotherapy.
A total of 108 consecutive patients were treated with salvage radiation therapy to 65 grays (Gy) in 26 fractions of 2.5 Gy. Median follow-up was 32.4 months. Median presalvage prostate-specific antigen (PSA) was 0.44 (range, 0.05-9.50). Eighteen (17%) patients received androgen deprivation after surgery or concurrently with radiation.
The actuarial freedom from biochemical failure for the entire group at 4 years was 67% ± 5.3%. An identical 67% control rate was seen at 5 years for the first 50 enrolled patients, whose median follow-up was longer at 43 months. One acute grade 3 genitourinary toxicity occurred, with no acute grade 3 gastrointestinal and no late grade 3 toxicities observed. On univariate analysis, higher Gleason score (P = .006), PSA doubling time ≤12 months (P = .03), perineural invasion (P = .06), and negative margins (P = .06) showed association with unsuccessful salvage. On multivariate analysis, higher Gleason score (P = .057) and negative margins (P = .088) retained an association with biochemical failure.
Hypofractionated radiotherapy (65 Gy in 2.5 Gy fractions in about 5 weeks) reduces the length of treatment by from 1-½ to 3 weeks relative to other treatment schedules commonly used, produces low rates of toxicity, and demonstrates encouraging efficacy at 4 to 5 years. Hypofractionation may provide a convenient, resource-efficient, and well-tolerated salvage approach for the estimated 20,000 to 35,000 US men per year experiencing biochemical recurrence after prostatectomy.
前列腺切除术后辅助或挽救性放疗，采用标准分割时，需要 6.5 至 8 周的治疗时间。作者报告了一种加快挽救性前列腺放疗疗程的安全性和有效性。
共对 108 例连续患者进行了挽救性放疗，放疗剂量为 65 戈瑞（Gy），26 次，每次 2.5 Gy。中位随访时间为 32.4 个月。中位挽救前前列腺特异性抗原（PSA）为 0.44（范围：0.05-9.50）。18 例（17%）患者在手术后或同时接受了雄激素剥夺治疗。
整个组的生化无失败 actuarial 率在 4 年内为 67%±5.3%。前 50 例入组患者的中位随访时间较长，为 43 个月，其 5 年的控制率也为 67%。仅发生 1 例急性 3 级泌尿生殖系统毒性，未见急性 3 级胃肠道毒性和晚期 3 级毒性。单因素分析显示，较高的 Gleason 评分（P=0.006）、PSA 倍增时间≤12 个月（P=0.03）、神经周围侵犯（P=0.06）和阴性切缘（P=0.06）与挽救性治疗失败相关。多因素分析显示，较高的 Gleason 评分（P=0.057）和阴性切缘（P=0.088）与生化失败仍相关。
与其他常用治疗方案相比，缩短治疗时间 1-1/2 至 3 周的低分割放疗（2.5 Gy 分次 65 Gy，约 5 周），产生的毒性低，4 至 5 年时疗效令人鼓舞。对于每年估计有 20,000 至 35,000 名接受前列腺切除术的男性发生生化复发的患者，低分割可能为挽救性治疗提供一种方便、资源高效且耐受良好的方法。
