Couñago Felipe, Díaz Gavela Ana Aurora, Sancho Gemma, Ortiz Irene, Marcos Francisco José, Recio Manuel, Fernández Julio, Cano Raquel, Jiménez Mar, Thuissard Israel J, Sanz-Rosa David, Castro Nováis Juan, Pardo Eduardo, Molina Yolanda, Pérez García Hugo, Del Cerro Elia
Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain.
Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain.
Rep Pract Oncol Radiother. 2019 Sep-Oct;24(5):472-480. doi: 10.1016/j.rpor.2019.07.008. Epub 2019 Aug 8.
To analyse the efficacy and toxicity of postprostatectomy SRT in patients with a BCR evaluated with mpMRI.
Multiparametric magnetic resonance imaging (mpMRI) has the ability to detect the site of pelvic recurrence in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). However, we do not know the oncological outcomes of mpMRI-guided savage radiotherapy (SRT).
Local, lymph node, and pelvic bone recurrence was observed in 13, 4 and 2 patients, respectively. PSA levels were significantly lower in patients with negative mpMRI (0.4 ng/mL [0.4]) vs. positive mpMRI (2.2 ng/mL [4.1], = 0.003). Median planning target volume doses in patients with visible vs. non-visible recurrences were 76 Gy vs. 70 Gy. Overall, mean follow-up was 41 months (6-81). Biochemical relapse-free survival (bRFS) at 3 years was 82.3% and 82.5%, respectively, for the negative and positive mpMRI groups ( = 0.800). Three-year rates of late grade ≥2 urinary and rectal toxicity were 14.8% and 1.9%, respectively; all but one patient recovered without sequelae.
SRT to the macroscopic recurrence identified by mpMRI is a feasible and well-tolerated option. In this study, there were no differences in bRFS between MRI-positive and MRI-negative patients, indicating effective targeting of MRI-positive lesions.
分析经多参数磁共振成像（mpMRI）评估为生化复发（BCR）的前列腺切除术后患者接受挽救性放疗（SRT）的疗效和毒性。
多参数磁共振成像（mpMRI）能够检测根治性前列腺切除术（RP）后生化复发（BCR）患者的盆腔复发部位。然而，我们尚不清楚mpMRI引导下的挽救性放疗（SRT）的肿瘤学结局。
分别在13例、4例和2例患者中观察到局部、淋巴结和盆腔骨复发。mpMRI阴性患者的前列腺特异抗原（PSA）水平显著低于mpMRI阳性患者（0.4 ng/mL [0.4] 对比2.2 ng/mL [4.1]，P = 0.003）。可见复发与不可见复发患者的计划靶区中位剂量分别为76 Gy和70 Gy。总体而言，平均随访时间为41个月（6 - 81个月）。mpMRI阴性和阳性组3年的无生化复发生存率（bRFS）分别为82.3%和82.5%（P = 0.800）。3年≥2级晚期泌尿和直肠毒性发生率分别为14.8%和1.9%；除1例患者外，所有患者均康复且无后遗症。
对mpMRI识别的宏观复发进行SRT是一种可行且耐受性良好的选择。在本研究中，MRI阳性和MRI阴性患者的bRFS无差异，表明MRI阳性病变得到了有效靶向治疗。
