Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):960-5. doi: 10.1016/j.ijrobp.2011.09.007. Epub 2011 Dec 13.
To retrospectively evaluate the outcome and toxicity in patients receiving high-dose (>69 Gy) adjuvant radiotherapy (HD-ART) and the impact of androgen deprivation therapy (ADT).
Between 1999 and 2008, 225 node-negative patients were referred for HD-ART with or without ADT to two large academic institutions. Indications for HD-ART were extracapsular extension, seminal vesicle invasion (SVI), and/or positive surgical margins at radical prostatectomy (RP). A dose of at least 69.1 Gy was prescribed to the prostate bed and seminal vesicle bed. The ADT consisted of a luteinizing hormone-releasing hormone analog. The duration and indication of ADT was left at the discretion of the treating physician. The effect of HD-ART and ADT on biochemical (bRFS) and clinical (cRFS) relapse-free survival was examined through univariate and multivariate analysis, with correction for known patient- and treatment-related variables. Interaction terms were introduced to evaluate effect modification.
After a median follow-up time of 5 years, the 7-year bRFS and cRFS were 84% and 88%, respectively. On multivariate analysis, the addition of ADT was independently associated with an improved bRFS (hazard ratio [HR] 0.4, p = 0.02) and cRFS (HR 0.2, p = 0.008). Higher Gleason scores and SVI were associated with decreased bRFS and cRFS. A lymphadenectomy at the time of RP independently improved cRFS (HR 0.09, p = 0.009). The 7-year probability of late Grade 2-3 toxicity was 29% and 5% for genitourinary (GU) and gastrointestinal (GI) symptoms, respectively. The absolute incidence of Grade 3 toxicity was <1% and 10% for GI and GU symptoms, respectively. The study is limited by its retrospective design and the lack of a standardized use of ADT.
This retrospective study shows significantly improved bRFS and cRFS rates with the addition of ADT to HD-ART, with low Grade 3 gastrointestinal toxicity and 10% Grade 3 genitourinary toxicity.
回顾性评估接受高剂量(>69 Gy)辅助放疗(HD-ART)和去势治疗(ADT)的患者的结果和毒性。
1999 年至 2008 年期间,两家大型学术机构收治了 225 例淋巴结阴性患者,接受 HD-ART 治疗,同时或不接受 ADT。HD-ART 的适应证为包膜外扩展、精囊受侵(SVI)和/或根治性前列腺切除术后切缘阳性。处方剂量至少为 69.1 Gy 用于前列腺床和精囊床。ADT 包括黄体生成素释放激素类似物。ADT 的持续时间和适应证由治疗医生决定。通过单变量和多变量分析,结合已知的患者和治疗相关变量,检查 HD-ART 和 ADT 对生化(bRFS)和临床(cRFS)无复发生存的影响,并进行校正。引入交互项来评估效应修饰。
中位随访时间 5 年后,7 年 bRFS 和 cRFS 分别为 84%和 88%。多变量分析显示,ADT 的加入与 bRFS(风险比 [HR] 0.4,p = 0.02)和 cRFS(HR 0.2,p = 0.008)的改善独立相关。较高的 Gleason 评分和 SVI 与 bRFS 和 cRFS 的降低相关。RP 时行淋巴结清扫术可独立改善 cRFS(HR 0.09,p = 0.009)。7 年时,泌尿生殖系统(GU)和胃肠道(GI)症状的 2 级-3 级毒性的发生率分别为 29%和 5%。GI 和 GU 症状的 3 级毒性的绝对发生率分别为<1%和 10%。该研究受到回顾性设计和 ADT 标准化使用缺乏的限制。
这项回顾性研究表明,在 HD-ART 中加入 ADT 可显著提高 bRFS 和 cRFS 率,胃肠道毒性为 3 级,泌尿生殖系统毒性为 10%。