Department of Radiation Oncology, Isesaki Municipal Hospital, Tsunatorimoto 12-1, Isesaki, 372-0802 Gunma, Japan.
Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Anagawa 4-9-7, Inage, 263-8555 Chiba, Japan.
J Radiat Res. 2020 Nov 16;61(6):908-919. doi: 10.1093/jrr/rraa074.
The feasibility and efficacy of hypofractionated salvage radiotherapy (HS-RT) for prostate cancer (PC) with biochemical recurrence (BR) after prostatectomy, and the usefulness of prostate-specific antigen (PSA) kinetics as a predictor of BR, were evaluated in 38 patients who received HS-RT without androgen deprivation therapy between May 2009 and January 2017. Their median age, PSA level and PSA doubling time (PSA-DT) at the start of HS-RT were 68 (53-74) years, 0.28 (0.20-0.79) ng/ml and 7.7 (2.3-38.5) months, respectively. A total dose of 60 Gy in 20 fractions (three times a week) was three-dimensionally delivered to the prostate bed. After a median follow-up of 62 (30-100) months, 19 (50%) patients developed a second BR after HS-RT, but only 1 patient died before the last follow-up. The 5-year overall survival and BR-free survival rates were 97.1 and 47.4%, respectively. Late grade 2 gastrointestinal and genitourinary morbidities were observed in 0 and 5 (13%) patients, respectively. The PSA level as well as pathological T-stage and surgical margin status were regarded as significant predictive factors for a second BR by multivariate analysis. BR developed within 6 months after HS-RT in 11 (85%) of 13 patients with a PSA-DT < 10 months compared with 1 (17%) of 6 with a PSA-DT ≥ 10 months (median time to BR: 3 vs 14 months, P < 0.05). Despite the small number of patients, our HS-RT protocol seems feasible, and PSA kinetics may be useful for predicting the risk of BR and determining the appropriate follow-up schedule.
在 2009 年 5 月至 2017 年 1 月期间，38 例前列腺癌（PC）患者在未接受雄激素剥夺治疗的情况下接受了高分割挽救性放疗（HS-RT），评估了其在前列腺切除术后生化复发（BR）中的可行性和疗效，以及前列腺特异性抗原（PSA）动力学作为 BR 预测因子的有用性。这些患者的中位年龄、HS-RT 起始时的 PSA 水平和 PSA 倍增时间（PSA-DT）分别为 68（53-74）岁、0.28（0.20-0.79）ng/ml 和 7.7（2.3-38.5）个月。前列腺床采用三维方式给予 60Gy 共 20 个分割（每周 3 次）。中位随访 62（30-100）个月后，19（50%）例患者在 HS-RT 后发生第二次 BR，但只有 1 例患者在最后一次随访前死亡。5 年总生存率和 BR 无复发生存率分别为 97.1%和 47.4%。0 和 5（13%）例患者分别观察到迟发性 2 级胃肠道和泌尿生殖系统并发症。多因素分析显示，PSA 水平以及病理 T 分期和手术切缘状态是二次 BR 的显著预测因素。在 PSA-DT<10 个月的 13 例患者中，11 例（85%）患者在 HS-RT 后 6 个月内发生 BR，而 PSA-DT≥10 个月的 6 例患者中仅 1 例（17%）发生 BR（中位 BR 时间：3 个月 vs 14 个月，P<0.05）。尽管患者人数较少，但我们的 HS-RT 方案似乎是可行的，PSA 动力学可能有助于预测 BR 风险，并确定适当的随访时间表。
