Department of Radiation Oncology, University of California, Davis School of Medicine, Davis, California, USA.
Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):822-8. doi: 10.1016/j.ijrobp.2013.05.029.
The purpose of this guideline was to provide a clinical framework for the use of radiation therapy after radical prostatectomy as adjuvant or salvage therapy.
A systematic literature review using PubMed, Embase, and Cochrane database was conducted to identify peer-reviewed publications relevant to the use of radiation therapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed.
Guideline statements are provided for patient counseling, use of radiation therapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a restaging evaluation.
Physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invastion, positive surgical margins, extraprostatic extension) and salvage radiation therapy to patients with prostate-specific antigen (PSA) or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiation therapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiation therapy as well as the potential benefits of preventing recurrence. The decision to administer radiation therapy should be made by the patient and the multidisciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. The American Society for Radiation Oncology and American Urological Association websites show this guideline in its entirety, including the full literature review.
本指南的目的是为根治性前列腺切除术后辅助或挽救性放疗提供临床框架。
使用 PubMed、Embase 和 Cochrane 数据库进行系统文献回顾，以确定与前列腺切除术后放疗使用相关的同行评议出版物。该综述产生了 294 篇文章；这些出版物被用于创建基于证据的指南陈述。当证据不足时，提供了额外的指导作为临床原则。
为患者咨询、辅助和挽救性放疗的使用、定义生化复发以及进行重新分期评估提供了指南陈述。
对于前列腺切除术后有不良病理发现（即精囊侵犯、手术切缘阳性、前列腺外延伸）的患者，医生应提供辅助放疗，对于前列腺特异性抗原（PSA）或前列腺切除术后局部复发且无远处转移疾病证据的患者，应提供挽救性放疗。在提供放疗时，应考虑放疗的短期和长期副作用以及预防复发的潜在益处，与患者进行深思熟虑的讨论。是否进行放疗的决定应由患者和多学科治疗团队做出，充分考虑患者的病史、价值观、偏好、生活质量和功能状态。美国放射肿瘤学会和美国泌尿外科学会的网站展示了本指南的全文，包括完整的文献综述。
