Botticella Angela, Guarneri Alessia, Levra Niccolo' Giai, Munoz Fernando, Filippi Andrea Riccardo, Rondi Nadia, Badellino Serena, Arcadipane Francesca, Levis Mario, Ragona Riccardo, Ricardi Umberto
Radiation Oncology Unit, Department of Oncology, University of Torino, Via Genova 3, 10126, Turin, Italy,
J Cancer Res Clin Oncol. 2014 Jul;140(7):1111-6. doi: 10.1007/s00432-014-1673-8. Epub 2014 Apr 18.
To retrospectively evaluate the role of high-dose salvage radiotherapy (SRT) alone with regard to biochemical and clinical outcomes in patients with biochemical failure (BF) after radical prostatectomy (RP).
Between January 2003 and August 2011, 168 hormone-naïve localized prostate cancer patients received SRT alone for post-RP BF in a single institution and were retrospectively analyzed. Multivariate analysis was performed to determine the independent prognostic impact of clinical factors on biochemical and clinical outcomes [biochemical relapse-free survival (bRFS), clinical relapse-free survival (cRFS), cancer-specific survival (CSS) and overall survival (OS)].
Median follow-up was 54 months. Actuarial bRFS, cRFS, CSS and OS at 5 years were, respectively, 64, 86.2, 94.5 and 96.3 %. On multivariate analysis, nadir PSA (nPSA) after SRT was significantly associated with bRFS (HR 15, p = 0.001) and cRFS (HR 9, p = 0.001), while CSS was associated with RT dose (≥70 Gy; HR 1.9 p = 0.023), pre-RT PSA (<1.5 vs. ≥1.5 ng/mL; HR 1.3, p = 0.008) and age (>75 years; HR 1.2, p = 0.05). OS was significantly correlated with pre-SRT PSA (linear correlation; HR 1.1, p = 0.023) and age (<75 vs. ≥ 75 years; HR 1.1, p = 0.026).
Effective biochemical and clinical control rates may be safely achieved administering SRT with high doses (≥72 Gy) and using conformal techniques, especially in older patients presenting with lower pre-SRT PSA values. A lower nPSA after SRT predicts for better 5 years bRFS and cRFS rates.
回顾性评估单纯大剂量挽救性放疗（SRT）对前列腺癌根治术（RP）后生化复发（BF）患者生化及临床结局的作用。
2003年1月至2011年8月期间，168例初治激素非依赖性局限性前列腺癌患者在单一机构接受单纯SRT治疗RP后BF，并进行回顾性分析。进行多因素分析以确定临床因素对生化及临床结局[生化无复发生存期（bRFS）、临床无复发生存期（cRFS）、癌症特异性生存期（CSS）和总生存期（OS）]的独立预后影响。
中位随访时间为54个月。5年时的精算bRFS、cRFS、CSS和OS分别为64%、86.2%、94.5%和96.3%。多因素分析显示，SRT后的最低点PSA（nPSA）与bRFS（HR 15，p = 0.001）和cRFS（HR 9，p = 0.001）显著相关，而CSS与放疗剂量（≥70 Gy；HR 1.9，p = 0.023）、放疗前PSA（<1.5 vs.≥1.5 ng/mL；HR 1.3，p = 0.008）和年龄（>75岁；HR 1.2，p = 0.05）相关。OS与放疗前PSA（线性相关；HR 1.1，p = 0.023）和年龄（<75岁vs.≥75岁；HR 1.1，p = 0.026）显著相关。
采用高剂量（≥72 Gy）并使用适形技术进行SRT，可安全实现有效的生化和临床控制率，尤其是对于放疗前PSA值较低的老年患者。SRT后较低的nPSA预示着5年bRFS和cRFS率更佳。
