Department of Radiation Oncology, Charité Universitätsmedizin, Berlin, Germany.
Radiother Oncol. 2012 May;103(2):239-43. doi: 10.1016/j.radonc.2011.10.024. Epub 2011 Nov 25.
Salvage radiotherapy (SRT) is applied routinely in patients with biochemical relapse after radical prostatectomy (RP). However, only ∼30% of these patients achieve a durable response after 10 years. As a standard, 66 Gy are given, ideally with a PSA below 0.5 ng/ml. We tried to determine more precisely the optimal PSA for starting SRT.
In 301 prostate cancer patients without hormonal treatment, we analysed the impact on the biochemical response (bNED) to SRT of two pre-SRT PSA levels, namely below or above the median of 0.28 ng/ml.
The median follow-up time for the entire group was 30 months. In 151 patients, SRT commenced at a PSA ≤ 0.28 ng/ml, in 150 at > 0.28 ng/ml. Eighty-two patients (27%) developed biochemical progression during follow up. The calculated two-year bNED was 74% for the entire group, 78% versus 61% for a PSA ≤ or > 0.28 ng/ml, respectively. In multivariate analysis, pT(3b), resection status, pre-SRT PSA dichotomized at median, PSA post-SRT undetectable, and PSA doubling time were statistically significant independent predictors of progression after SRT.
Our findings suggest that a PSA of ≤ 0.28 ng/ml improves bNED compared with a PSA before SRT of > 0.28 ng/ml.
挽救性放疗（SRT）在根治性前列腺切除术（RP）后生化复发的患者中常规应用。然而，这些患者中只有约 30%在 10 年后能获得持久缓解。作为标准，给予 66 Gy，理想情况下 PSA 低于 0.5 ng/ml。我们试图更精确地确定开始 SRT 的最佳 PSA 值。
在 301 例未接受激素治疗的前列腺癌患者中，我们分析了 SRT 前 PSA 水平（低于或高于 0.28 ng/ml 的中位数）对生化缓解（bNED）的影响。
整个组的中位随访时间为 30 个月。在 151 例 PSA≤0.28 ng/ml 的患者中开始 SRT，在 150 例 PSA＞0.28 ng/ml 的患者中开始 SRT。151 例患者中有 82 例（27%）在随访期间发生生化进展。整个组的两年 bNED 计算为 74%，PSA≤0.28 ng/ml 和 PSA＞0.28 ng/ml 分别为 78%和 61%。多变量分析显示，pT（3b）、切除状态、SRT 前 PSA 中位数分组、SRT 后 PSA 不可检测和 PSA 倍增时间是 SRT 后进展的统计学上显著独立预测因素。
我们的发现表明，与 SRT 前 PSA＞0.28 ng/ml 相比，PSA≤0.28 ng/ml 可改善 bNED。
