Huang Ying-Che, Kang Chih-Hsiung, Lee Wei-Chia, Cheng Yuan-Tso, Chuang Yao-Chi, Wang Hung-Jen, Fang Fu-Min, Chiang Po-Hui
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
J Clin Med. 2022 Jul 30;11(15):4450. doi: 10.3390/jcm11154450.
We conduct a retrospective analysis of salvage radiotherapy plus androgen deprivation therapy (SRT+ADT) for high-risk prostate cancer patients with biochemical failure after high-intensity focused ultrasound (HIFU) as the primary treatment. A total of 38 patients, who met the criteria of biochemical failure and were consecutively treated with SRT+ADT, were enrolled. All patients received intensity modulated radiotherapy with a median dose of 70 Gy to the clinical target volume. ADT was given before, during or after the course of SRT with the duration of ≦6 months (n = 14), 6−12 months (n = 12) or >12 months (n = 12). The median follow-up was 45.9 months. A total of 10 (26.3%) patients had biochemical failure after SRT+ADT. The cumulative 5-year biochemical progression free survival (b-PFS) and overall survival (OS) rate was 73.0% and 80.3%, respectively. A nadir prostate-specific antigen (nPSA) value 0.02 ng/mL was observed to predict the b-PFS in multivariate analysis. The 5-year b-PFS was 81.6% for those with nPSA < 0.02 compared with 25.0% with nPSA ≧ 0.02. The adverse effects related to SRT+ADT were mild in most cases and only three (8%) patients experienced grade 3 urinary toxicities. For high-risk prostate cancer after HIFU as primary treatment with biochemical failure, our study confirms the feasibility of SRT+ADT with high b-PFS, OS and low toxicity.
我们对以高强度聚焦超声（HIFU）作为主要治疗方法后出现生化复发的高危前列腺癌患者进行挽救性放疗联合雄激素剥夺治疗（SRT+ADT）的回顾性分析。共有38例符合生化复发标准并连续接受SRT+ADT治疗的患者入组。所有患者均接受调强放疗，临床靶区中位剂量为70 Gy。ADT在SRT疗程之前、期间或之后给予，持续时间≤6个月（n = 14）、6 - 12个月（n = 12）或>12个月（n = 12）。中位随访时间为45.9个月。共有10例（26.3%）患者在SRT+ADT后出现生化复发。5年累积无生化进展生存率（b-PFS）和总生存率（OS）分别为73.0%和80.3%。在多因素分析中，观察到前列腺特异性抗原最低点（nPSA）值0.02 ng/mL可预测b-PFS。nPSA < 0.02的患者5年b-PFS为81.6%，而nPSA≥0.02的患者为25.0%。大多数情况下，与SRT+ADT相关的不良反应较轻，只有3例（8%）患者出现3级泌尿系统毒性。对于以HIFU作为主要治疗方法后出现生化复发的高危前列腺癌，我们的研究证实了SRT+ADT具有高b-PFS、OS且毒性低的可行性。
