Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer. 2013 Sep 15;119(18):3265-71. doi: 10.1002/cncr.28213. Epub 2013 Jun 24.
Men with high-risk prostate cancer are often thought to have very poor outcomes in terms of disease control and survival even after definitive treatment. However, results after external beam radiotherapy have improved significantly through dose escalation and the use of androgen deprivation therapy (ADT). This report describes long-term findings after low-dose (< 75.6 Gy) or high-dose (≥ 75.6 Gy) external beam radiation, with or without ADT.
This analysis included 741 men with high-risk prostate cancer (clinical classification ≥ T3, Gleason score ≥ 8, or prostate-specific antigen level ≥ 20 ng/mL) treated with external beam radiotherapy at a single tertiary institution from 1987 through 2004. The radiation dose ranged from 60 to 79.3 Gy (median, 70 Gy); 295 men had received ADT for ≥ 2 years, and the median follow-up time was 8.3 years.
The 5- and 10-year actuarial overall survival rates were significantly better for men treated with the higher radiation dose (no ADT plus ≥ 75.6 Gy, 87.3% and 72.0%, respectively; and ADT plus ≥ 75.6 Gy, 92.3% and 72%, respectively) (P = .0035). The corresponding 5- and 10-year biochemical failure-free survival rates were significantly better for patients treated with both ADT and higher radiation dose (82% and 77%, P < .0001). At 5 years, men who had not received ADT and had received radiation dose < 75.6 Gy had higher clinical local failure rates than those given ADT and radiation dose ≥ 75.6 Gy (24.2% versus 0%, P < .0001). The 10-year symptomatic local failure rate was only 2% for all patients.
Contrary to lingering historical perceptions, treatment of high-risk prostate cancer with modern, high-dose, external beam radiotherapy and ADT can produce better biochemical, clinical, and survival outcomes over those from previous eras. Specifically, symptomatic local failure is uncommon, and few men die of prostate cancer even 10 or more years after treatment.
即使经过明确的治疗，患有高危前列腺癌的男性在疾病控制和生存方面通常也被认为预后较差。然而，通过提高剂量和使用雄激素剥夺疗法（ADT），外照射放疗的结果已得到显著改善。本报告描述了在低剂量（<75.6Gy）或高剂量（≥75.6Gy）外照射放疗，以及是否使用 ADT 的情况下，长期随访的结果。
本分析包括 1987 年至 2004 年期间在一家三级医疗机构接受外照射放疗的 741 名高危前列腺癌（临床分类≥T3、Gleason 评分≥8 或前列腺特异性抗原水平≥20ng/ml）男性。放射剂量范围为 60 至 79.3Gy（中位数 70Gy）；295 名男性接受了≥2 年的 ADT，中位随访时间为 8.3 年。
接受高剂量放疗的男性（无 ADT 加≥75.6Gy，分别为 87.3%和 72.0%；ADT 加≥75.6Gy，分别为 92.3%和 72%）的 5 年和 10 年总生存 actuarial 率显著提高（P=0.0035）。接受 ADT 和高剂量放疗的患者的 5 年和 10 年生化无失败生存率也显著提高（82%和 77%，P<0.0001）。5 年时，未接受 ADT 且接受放射剂量<75.6Gy 的男性临床局部失败率高于接受 ADT 和放射剂量≥75.6Gy 的男性（24.2%比 0%，P<0.0001）。所有患者的 10 年症状性局部失败率仅为 2%。
与挥之不去的历史观念相反，采用现代高剂量外照射放疗和 ADT 治疗高危前列腺癌，可以产生优于前几代的生化、临床和生存结果。具体来说，症状性局部失败并不常见，即使在治疗后 10 年或更长时间，也很少有男性死于前列腺癌。
