Department of Radiation Oncology, Bern University Hospital, Inselspital Bern, Freiburgstrasse, 3010, Bern, Switzerland.
Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Strahlenther Onkol. 2018 Jan;194(1):9-16. doi: 10.1007/s00066-017-1172-3. Epub 2017 Jun 27.
Although salvage radiotherapy (SRT) for PSA recurrence after radical prostatectomy provides better oncological outcomes when delivered early, in the absence of detectable disease many patients are treated for macroscopic locally recurrent tumors. Due to limited data from prospective studies, we hypothesized an important variability in the SRT management of these patients. Our aim was to investigate current practice patterns of SRT for local macroscopic recurrence after radical prostatectomy.
A total of 14 Swiss radiation oncology centers were asked to complete a survey on treatment specifications for macroscopic locally recurrent disease including information on pretherapeutic diagnostic procedures, dose prescription, radiation delivery techniques and androgen deprivation therapy (ADT). Treatment recommendations on ADT were analyzed using the objective consensus methodology.
The majority of centers recommended pretreatment magnetic resonance imaging (MRI) of the pelvis and choline positron emission tomography (PET). The median prescribed dose to the prostate bed was 66 Gy (range 65-72 Gy) with a boost to the macroscopic lesion used by 79% of the centers with a median total dose of 72 Gy (range 70-80 Gy). Intensity-modulated rotational techniques were used by all centers and daily cone beam computed tomography (CT) was recommended by 43%. The use of concomitant ADT for any macroscopic recurrence was recommended by 43% of the centers while the remaining centers recommended it only for high-risk disease, which was not consistently defined.
We observed a high variability of treatment paradigms when SRT is indicated for macroscopic local recurrences after prostatectomy. These data reflect the need for more standardized approaches and ultimately further research in this field.
虽然根治性前列腺切除术后 PSA 复发时进行挽救性放疗（SRT）可以更早地获得更好的肿瘤学结果，但由于许多患者接受治疗的是肉眼可见的局部复发性肿瘤，而实际上这些患者并无疾病可检测。由于前瞻性研究的数据有限，我们假设这些患者的 SRT 管理存在很大的差异。我们的目的是调查根治性前列腺切除术后局部复发性疾病进行 SRT 的当前治疗模式。
我们要求瑞士的 14 个放射肿瘤学中心完成一项关于治疗局部宏观复发疾病的治疗规范的调查，包括治疗前诊断程序、剂量处方、放射治疗技术和雄激素剥夺治疗（ADT）等信息。使用客观共识方法分析 ADT 的治疗建议。
大多数中心建议在治疗前进行骨盆磁共振成像（MRI）和胆碱正电子发射断层扫描（PET）检查。79%的中心推荐对前列腺床进行中位剂量为 66Gy（范围为 65-72Gy）的照射，并对 79%的中心进行宏观病变的局部推量治疗，总剂量中位数为 72Gy（范围为 70-80Gy）。所有中心均使用调强旋转技术，43%的中心建议每天进行锥形束 CT（CBCT）检查。43%的中心建议对任何肉眼可见的复发病灶使用同时进行 ADT，而其余中心仅建议对高危疾病（高危疾病并未明确界定）使用 ADT。
我们观察到，当需要进行 SRT 治疗前列腺切除术后的肉眼局部复发时，治疗方案存在很大的差异。这些数据反映出需要更标准化的方法，最终需要在该领域进行更多的研究。
