Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
Eur Urol. 2020 Jan;77(1):3-10. doi: 10.1016/j.eururo.2019.03.022. Epub 2019 Apr 13.
The role of elective whole-pelvis radiotherapy (WPRT) remains controversial. Few studies have investigated it in Gleason grade group (GG) 5 prostate cancer (PCa), known to have a high risk of nodal metastases.
To assess the impact of WPRT on patients with GG 5 PCa treated with external-beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT+BT).
DESIGN, SETTING, AND PARTICIPANTS: We identified 1170 patients with biopsy-proven GG 5 PCa from 11 centers in the United States and one in Norway treated between 2000 and 2013 (734 with EBRT and 436 with EBRT+BT).
Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific survival (PCSS) were compared using Cox proportional hazards models with propensity score adjustment.
A total of 299 EBRT patients (41%) and 320 EBRT+BT patients (73%) received WPRT. The adjusted 5-yr bRFS rates with WPRT in the EBRT and EBRT+BT groups were 66% and 88%, respectively. Without WPRT, these rates for the EBRT and EBRT+BT groups were 58% and 78%, respectively. The median follow-up was 5.6yr. WPRT was associated with improved bRFS among patients treated with EBRT+BT (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.2-0.9, p=0.02), but no evidence for improvement was found in those treated with EBRT (HR 0.8, 95% CI 0.6-1.2, p=0.4). WPRT was not significantly associated with improved DMFS or PCSS in the EBRT group (HR 1.1, 95% CI 0.7-1.7, p=0.8 for DMFS and HR 0.7, 95% CI 0.4-1.1, p=0.1 for PCSS), or in the EBRT+BT group (HR 0.6, 95% CI 0.3-1.4, p=0.2 for DMFS and HR 0.5 95% CI 0.2-1.2, p=0.1 for PCSS).
WPRT was not associated with improved PCSS or DMFS in patients with GG 5 PCa who received either EBRT or EBRT+BT. However, WPRT was associated with a significant improvement in bRFS among patients receiving EBRT+BT. Strategies to optimize WPRT, potentially with the use of advanced imaging techniques to identify occult nodal disease, are warranted.
When men with a high Gleason grade prostate cancer receive radiation with external radiation and brachytherapy, the addition of radiation to the pelvis results in a longer duration of prostate-specific antigen control. However, we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease. We also did not find a benefit for radiation to the pelvis in men who received radiation without brachytherapy.
全骨盆放疗（WPRT）的作用仍存在争议。很少有研究调查过 GG5 前列腺癌（PCa）患者，已知 GG5 前列腺癌患者有淋巴结转移的高风险。
评估 WPRT 对接受外照射放疗（EBRT）或 EBRT 联合近距离放疗（EBRT+BT）治疗的 GG5 PCa 患者的影响。
设计、地点和参与者：我们从美国 11 个中心和挪威的一个中心确定了 1170 名经活检证实的 GG5 PCa 患者，这些患者在 2000 年至 2013 年期间接受治疗（734 名接受 EBRT，436 名接受 EBRT+BT）。
使用 Cox 比例风险模型和倾向评分调整比较生化无复发生存率（bRFS）、远处转移无复发生存率（DMFS）和前列腺癌特异性生存率（PCSS）。
共有 299 名 EBRT 患者（41%）和 320 名 EBRT+BT 患者（73%）接受了 WPRT。在接受 EBRT 和 EBRT+BT 治疗的患者中，接受 WPRT 的 5 年 bRFS 率分别为 66%和 88%。在未接受 WPRT 的 EBRT 和 EBRT+BT 组中，这些比例分别为 58%和 78%。中位随访时间为 5.6 年。WPRT 与接受 EBRT+BT 治疗的患者的 bRFS 改善相关（风险比 [HR]0.5，95%置信区间 [CI]0.2-0.9，p=0.02），但在接受 EBRT 治疗的患者中未发现改善的证据（HR 0.8，95% CI 0.6-1.2，p=0.4）。在 EBRT 组（HR 1.1，95% CI 0.7-1.7，p=0.8 用于 DMFS 和 HR 0.7，95% CI 0.4-1.1，p=0.1 用于 PCSS）或 EBRT+BT 组（HR 0.6，95% CI 0.3-1.4，p=0.2 用于 DMFS 和 HR 0.5，95% CI 0.2-1.2，p=0.1 用于 PCSS），WPRT 与 DMFS 或 PCSS 的改善均无显著相关性。
在接受 EBRT 或 EBRT+BT 治疗的 GG5 PCa 患者中，WPRT 与 PCSS 或 DMFS 改善无关。然而，WPRT 与接受 EBRT+BT 治疗的患者 bRFS 的显著改善相关。有必要制定策略来优化 WPRT，可能需要使用先进的成像技术来识别隐匿性淋巴结疾病。
当患有高 Gleason 分级前列腺癌的男性接受外部放射治疗和近距离放射治疗时，骨盆放疗的增加会导致前列腺特异性抗原控制时间延长。然而，我们没有发现前列腺癌或无转移性疾病的生存时间有差异。我们也没有发现对于未接受近距离放射治疗的男性，骨盆放射治疗有获益。
