Shelan Mohamed, Odermatt Seline, Bojaxhiu Beat, Nguyen Daniel P, Thalmann George N, Aebersold Daniel M, Dal Pra Alan
Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Front Oncol. 2019 Feb 28;9:12. doi: 10.3389/fonc.2019.00012. eCollection 2019.
To retrospectively assess clinical outcomes and toxicity profile of prostate cancer patients treated with delayed dose-escalated image-guided salvage radiotherapy (SRT) for macroscopic local recurrence after radical prostatectomy (RP). We report on a cohort of 69 consecutive patients with local recurrence after RP and no evidence of regional or distant metastasis who were referred for salvage radiotherapy between 2007 and 2016. SRT consisted of 64-66 Gy (2 Gy/fraction) to the prostatic bed followed by dose escalation to 72-74 Gy (2Gy/fraction) to the macroscopic disease. All patients received concurrent short-term androgen deprivation therapy (ADT). Biochemical recurrence-free survival (bRFS) and clinical progression-free-survival (cPFS) were depicted using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predictors of survival outcomes. Baseline, acute, and late urinary and gastrointestinal (GI) toxicity rates were reported using CTCAE v4.03. Median time from RP to SRT was 66 months (IQR: 32-124). Median pre-SRT prostate-specific antigen (PSA) was 2.7 ng/ml (IQR: 0.9-6.5). Median follow-up after SRT was 38 months (IQR: 24-66). The 3- and 5-year bRFS were 58 and 44%, respectively. The 3- and 5-year cPFS were 91 and 76%, respectively. Median time from SRT to clinical disease progression was 102 months (IQR 77.5-165). At baseline, 3 patients (4%) had grade 3 urinary symptoms. Six patients (9%) developed acute and six patients (9%) developed late grade 3 urinary toxicity. Five patients (7%) had acute grade 2 GI toxicity. No acute grade 3 GI toxicity was reported. Late grade 3 GI toxicity was reported in one patient (1.5%). Delayed dose-escalated SRT combined with short-course ADT for macroscopic LR after RP was associated with 44% bRFS and 76% cPFS at 5 years. Albeit improved patient stratification is warranted, these data suggest that delayed SRT provides inferior tumor control compared to early intervention.
回顾性评估接受延迟剂量递增影像引导挽救性放疗（SRT）治疗根治性前列腺切除术（RP）后肉眼可见局部复发的前列腺癌患者的临床结局和毒性特征。我们报告了一组连续69例RP后局部复发且无区域或远处转移证据的患者，这些患者于2007年至2016年间被转诊接受挽救性放疗。SRT包括对前列腺床给予64 - 66 Gy（2 Gy/分次），然后对肉眼可见病灶剂量递增至72 - 74 Gy（2 Gy/分次）。所有患者均接受了同期短期雄激素剥夺治疗（ADT）。采用Kaplan-Meier法描述生化无复发生存期（bRFS）和临床无进展生存期（cPFS）。多变量Cox比例风险回归评估生存结局的预测因素。使用CTCAE v4.03报告基线、急性和晚期泌尿系统及胃肠道（GI）毒性发生率。从RP到SRT的中位时间为66个月（四分位间距：32 - 124）。SRT前前列腺特异性抗原（PSA）的中位值为2.7 ng/ml（四分位间距：0.9 - 6.5）。SRT后的中位随访时间为38个月（四分位间距：24 - 66）。3年和5年的bRFS分别为58%和44%。3年和5年的cPFS分别为91%和76%。从SRT到临床疾病进展的中位时间为102个月（四分位间距77.5 - 165）。基线时，3例患者（4%）有3级泌尿系统症状。6例患者（9%）出现急性3级泌尿系统毒性，6例患者（9%）出现晚期3级泌尿系统毒性。5例患者（7%）有急性2级GI毒性。未报告急性3级GI毒性。1例患者（1.5%）报告有晚期3级GI毒性。RP后肉眼可见局部复发的延迟剂量递增SRT联合短期ADT在5年时的bRFS为44%，cPFS为76%。尽管需要改进患者分层，但这些数据表明与早期干预相比，延迟SRT提供的肿瘤控制较差。
