Institute of Radiation Oncology, General Hospital and Perugia University, Perugia, Italy.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):e299-304. doi: 10.1016/j.ijrobp.2012.04.002. Epub 2012 May 8.
To evaluate outcome and toxicity of high-dose conformal radiotherapy (RT) after radical prostatectomy.
Between August 1998 and December 2007, 182 consecutive patients with positive resection margins and/or pT3-4, node-negative prostate adenocarcinoma underwent postoperative conformal RT. The prescribed median dose to the prostate/seminal vesicle bed was 66.6 Gy (range 50-70). Hormone therapy (a luteinizing hormone-releasing hormone analogue and/or antiandrogen) was administered to 110/182 (60.5%) patients with high-risk features. Biochemical relapse was defined as an increase of more than 0.2 ng/mL over the lowest postoperative prostate-specific antigen (PSA) value measured on 3 occasions, each at least 2 weeks apart.
Median follow-up was 55.6 months (range 7.6-141.9 months). The 3- and 5-year probability of biochemical relapse-free survival were 87% and 81%, respectively. In univariate analysis, more advanced T stages, preoperative PSA values ≥10 ng/mL, and RT doses <70 Gy were significant factors for biochemical relapse. Pre-RT PSA values >0.2 ng/mL were significant for distant metastases. In multivariate analysis, risk factors for biochemical relapse were higher preoperative and pre-RT PSA values, hormone therapy for under 402 days and RT doses of <70 Gy. Higher pre-RT PSA values were the only independent predictor of distant metastases. Acute genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 72 (39.6%) and 91 (50%) patients, respectively. There were 2 cases of Grade III GI toxicity but no cases of Grade IV. Late GU and GI toxicities occurred in 28 (15.4%) and 14 (7.7%) patients, respectively: 11 cases of Grade III toxicity: 1 GI (anal stenosis) and 10 GU, all urethral strictures requiring endoscopic urethrotomy.
Postoperative high-dose conformal RT in patients with high-risk features was associated with a low risk of biochemical relapse as well as minimal morbidity.
评估根治性前列腺切除术后高剂量适形放疗的疗效和毒性。
1998 年 8 月至 2007 年 12 月，182 例前列腺腺癌术后切缘阳性或 pT3-4、淋巴结阴性的患者接受了术后适形放疗。前列腺/精囊床的规定中位剂量为 66.6 Gy（范围 50-70）。110/182（60.5%）例高危特征患者接受了激素治疗（促黄体激素释放激素类似物和/或抗雄激素）。生化复发定义为 3 次至少相隔 2 周的最低术后前列腺特异性抗原（PSA）值增加超过 0.2 ng/mL。
中位随访时间为 55.6 个月（范围 7.6-141.9 个月）。3 年和 5 年的生化无复发生存率分别为 87%和 81%。单因素分析显示，较高的 T 分期、术前 PSA 值≥10 ng/mL 和 RT 剂量<70 Gy 是生化复发的显著因素。RT 前 PSA 值>0.2 ng/mL 是远处转移的显著因素。多因素分析显示，生化复发的危险因素是术前和 RT 前 PSA 值较高、激素治疗<402 天和 RT 剂量<70 Gy。较高的 RT 前 PSA 值是远处转移的唯一独立预测因素。急性泌尿生殖系统（GU）和胃肠道（GI）毒性分别发生在 72（39.6%）和 91（50%）例患者中。有 2 例 III 级 GI 毒性，但没有 IV 级毒性。晚期 GU 和 GI 毒性分别发生在 28（15.4%）和 14（7.7%）例患者中：11 例 III 级毒性：1 例 GI（肛门狭窄）和 10 例 GU，所有尿道狭窄均需内镜尿道扩张。
高危特征患者术后高剂量适形放疗具有生化复发风险低、发病率低的特点。
