Daniels Christopher P, Millar Jeremy L, Spelman Tim, Sengupta Shomik, Evans Sue M
Department of Radiation Oncology, Alfred Hospital, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2016 Apr;60(2):247-54. doi: 10.1111/1754-9485.12407. Epub 2015 Nov 9.
Long-term data from three randomized trials have demonstrated that adjuvant radiation therapy (ART) reduces the rate of biochemical failure in high-risk men following radical prostatectomy (RP). One of these trials has shown a survival advantage. We investigated the rate of ART in Victoria and the predictors for this treatment.
We analysed data from eligible patients who were notified to the Victorian Prostate Cancer Registry (PCR) by 37 Victorian hospitals between 1 August 2008 and 31 October 2011. We defined ART as radiation therapy (RT) delivered within 6 months of RP. Predictors of ART receipt were modelled using adjusted and unadjusted logistic regression.
There were 4626 eligible cases from which 2018 underwent RP with recorded date of surgery. Of these eligible prostatectomy cases, a total of 89 received ART. A subgroup of 833 men had an adverse pathologic feature, of whom 78 received ART. In a multivariate model, pathologic tumour stage pT3a (odds ratio (OR) 2.64; 95% confidence interval (CI) 1.4-5.00; P = 0.003), pT3b (OR 4.58; 95% CI 2.12-9.89; P = 0.000), a positive surgical margin (OR 8.91; 95% CI 4.61-17.2; P = 0.000) and pathologic Gleason grade >7 (OR 7.18; 95% CI 1.54-33.6; P = 0.012) predicted receipt of ART.
Adverse pathologic features and high pathologic Gleason score predict for receiving ART in Victorian men after RP, but overall, ART is not commonly prescribed. This finding is consistent with other published series and may reflect clinician scepticism regarding the benefit of ART over salvage RT and concern about toxicity and the risk of over treatment.
三项随机试验的长期数据表明，辅助放疗（ART）可降低高危男性根治性前列腺切除术（RP）后生化失败的发生率。其中一项试验显示出生存优势。我们调查了维多利亚州ART的使用率及其治疗的预测因素。
我们分析了2008年8月1日至2011年10月31日期间维多利亚州37家医院通知维多利亚州前列腺癌登记处（PCR）的符合条件患者的数据。我们将ART定义为RP后6个月内进行的放射治疗（RT）。使用调整和未调整的逻辑回归对接受ART的预测因素进行建模。
共有4626例符合条件的病例，其中2018例接受了RP并记录了手术日期。在这些符合条件的前列腺切除术病例中，共有89例接受了ART。833名男性的亚组具有不良病理特征，其中78例接受了ART。在多变量模型中，病理肿瘤分期pT3a（优势比（OR）2.64；95%置信区间（CI）1.4 - 5.00；P = 0.003）、pT3b（OR 4.58；95% CI 2.12 - 9.89；P = 0.000）、手术切缘阳性（OR 8.91；95% CI 4.61 - 17.2；P = 0.000）和病理Gleason分级>7（OR 7.18；95% CI 1.54 - 33.6；P = 0.012）可预测接受ART。
不良病理特征和高病理Gleason评分可预测维多利亚州男性RP后接受ART，但总体而言，ART的处方并不常见。这一发现与其他已发表的系列研究一致，可能反映了临床医生对ART相对于挽救性放疗的益处持怀疑态度，以及对毒性和过度治疗风险的担忧。
