Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin-Franklin, Berlin, Germany.
Strahlenther Onkol. 2011 Aug;187(8):467-72. doi: 10.1007/s00066-011-2229-3. Epub 2011 Jul 22.
The optimal dose for salvage radiotherapy (SRT) after radical prostatectomy (RP) is still not defined. It should be at least 66 Gy. In the present study, the suitability of PSA regression as a selection criterion for an SRT dose escalation to 70.2 Gy was examined.
Between 1997 and 2007, 301 prostate cancer patients received SRT after RP at the Charité - University Medicine Berlin, Campus Benjamin Franklin. None of the patients had antihormone therapy prior to SRT. A total of 234 patients received 66.6 Gy. From 2002 on, 67 patients with a PSA decrease during SRT were irradiated with 70.2 Gy. The influence of this selection and dose escalation on freedom from biochemical progression (bNED) was analyzed.
The median follow-up of the whole group was 30 months, the median pre-SRT PSA was 0.28 ng/ml. Of the patients, 27% (82/301) developed biochemical progression, 31% from the 66.6 Gy cohort (73/292) and 13% from the 70.2 Gy cohort (9/67) (p = 0.01). The calculated 2-years bNED was 74% for the whole group, 88% vs. 71% after 70.2 Gy and 66.6 Gy, respectively (p = 0.01). In a multivariate analysis, the total dose (p = 0.017), the re-achievement of an undetectable PSA after SRT (p = 0.005), and the infiltration of the seminal vesicles (p = 0.049) were independent parameters of bNED.
Our analysis suggests that patient selection during SRT for a dose escalation to 70.2 Gy can improve the freedom from biochemical progression in patients with SRT after RP.
根治性前列腺切除术（RP）后挽救性放疗（SRT）的最佳剂量仍未确定。剂量至少应为 66Gy。本研究旨在探讨 PSA 下降是否适合作为 SRT 剂量递增至 70.2Gy 的选择标准。
1997 年至 2007 年，301 例前列腺癌患者在柏林夏洛蒂医科大学本杰明富兰克林校区接受 RP 后行 SRT。SRT 前，所有患者均未接受抗激素治疗。234 例患者接受 66.6Gy 照射。自 2002 年起，67 例 SRT 期间 PSA 下降的患者接受 70.2Gy 照射。分析该选择和剂量递增对生化无进展生存（bNED）的影响。
全组中位随访时间为 30 个月，中位 SRT 前 PSA 为 0.28ng/ml。27%（82/301）的患者发生生化进展，66.6Gy 组为 31%（73/292），70.2Gy 组为 13%（9/67）（p=0.01）。全组患者 2 年 bNED 为 74%，70.2Gy 和 66.6Gy 组分别为 88%和 71%（p=0.01）。多因素分析显示，总剂量（p=0.017）、SRT 后 PSA 达到不可检测水平（p=0.005）和精囊浸润（p=0.049）是 bNED 的独立参数。
本研究提示，RP 后 SRT 期间进行剂量递增的患者选择，可以改善 RP 后行 SRT 的患者的生化无进展生存。
