Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):693-9. doi: 10.1016/j.ijrobp.2012.06.030. Epub 2012 Jul 24.
The benefit of adding androgen deprivation therapy (ADT) to dose-escalated radiation therapy (RT) for men with intermediate-risk prostate cancer is unclear; therefore, we assessed the impact of adding ADT to dose-escalated RT on freedom from failure (FFF).
Three groups of men treated with intensity modulated RT or 3-dimensional conformal RT (75.6-78 Gy) from 1993-2008 for prostate cancer were categorized as (1) 326 intermediate-risk patients treated with RT alone, (2) 218 intermediate-risk patients treated with RT and ≤6 months of ADT, and (3) 274 low-risk patients treated with definitive RT. Median follow-up was 58 months. Recursive partitioning analysis based on FFF using Gleason score (GS), T stage, and pretreatment PSA concentration was applied to the intermediate-risk patients treated with RT alone. The Kaplan-Meier method was used to estimate 5-year FFF.
Based on recursive partitioning analysis, intermediate-risk patients treated with RT alone were divided into 3 prognostic groups: (1) 188 favorable patients: GS 6, ≤T2b or GS 3+4, ≤T1c; (2) 71 marginal patients: GS 3+4, T2a-b; and (3) 68 unfavorable patients: GS 4+3 or T2c disease. Hazard ratios (HR) for recurrence in each group were 1.0, 2.1, and 4.6, respectively. When intermediate-risk patients treated with RT alone were compared to intermediate-risk patients treated with RT and ADT, the greatest benefit from ADT was seen for the unfavorable intermediate-risk patients (FFF, 74% vs 94%, respectively; P=.005). Favorable intermediate-risk patients had no significant benefit from the addition of ADT to RT (FFF, 94% vs 95%, respectively; P=.85), and FFF for favorable intermediate-risk patients treated with RT alone approached that of low-risk patients treated with RT alone (98%).
Patients with favorable intermediate-risk prostate cancer did not benefit from the addition of ADT to dose-escalated RT, and their FFF was nearly as good as patients with low-risk disease. In patients with GS 4+3 or T2c disease, the addition of ADT to dose-escalated RT did improve FFF.
对于中危前列腺癌患者，加用雄激素剥夺疗法（ADT）是否能获益于剂量递增放疗（RT）仍不明确；因此，我们评估了在剂量递增 RT 的基础上加用 ADT 对无失败生存（FFF）的影响。
1993 年至 2008 年间，3 组接受调强放疗或三维适形放疗（75.6-78 Gy）治疗的前列腺癌患者被分为：（1）326 例中危患者接受单纯 RT 治疗；（2）218 例中危患者接受 RT 加≤6 个月 ADT 治疗；（3）274 例低危患者接受根治性 RT 治疗。中位随访时间为 58 个月。对单纯接受 RT 治疗的中危患者进行基于无失败生存（FFF）的递归分区分析，采用 Gleason 评分（GS）、T 分期和治疗前 PSA 浓度。采用 Kaplan-Meier 法估计 5 年 FFF。
根据递归分区分析，单纯接受 RT 治疗的中危患者被分为 3 个预后组：（1）188 例有利组：GS=6，≤T2b 或 GS=3+4，≤T1c；（2）71 例边缘组：GS=3+4，T2a-b；（3）68 例不利组：GS=4+3 或 T2c 疾病。每组复发的危险比（HR）分别为 1.0、2.1 和 4.6。与单纯接受 RT 治疗的中危患者相比，单纯接受 RT 联合 ADT 治疗的不利中危患者获益最大（FFF 分别为 74%和 94%，P=.005）。单纯接受 RT 治疗的有利中危患者加用 ADT 无显著获益（FFF 分别为 94%和 95%，P=.85），且其 FFF 与单纯接受 RT 治疗的低危患者相当（98%）。
中危前列腺癌患者加用 ADT 不能获益于剂量递增 RT，其 FFF 与低危疾病患者相似。在 GS=4+3 或 T2c 疾病患者中，加用 ADT 可提高剂量递增 RT 的 FFF。
