Eulau S M, Tate D J, Stamey T A, Bagshaw M A, Hancock S L
Stanford University Medical Center, Department of Radiation Oncology, CA 94305, USA.
Int J Radiat Oncol Biol Phys. 1998 Jul 1;41(4):735-40. doi: 10.1016/s0360-3016(98)00127-8.
To evaluate whether transient androgen deprivation improves outcome in patients irradiated after radical prostatectomy for locally advanced disease, persistent or rising postoperative prostate specific antigen (PSA), or local recurrence.
Records of 105 consecutive patients who were treated with pelvic irradiation after radical retropubic prostatectomy between August 1985 and December 1995 were reviewed. Seventy-four patients received radiation alone (mean follow up: 4.6 years), and 31 received transient androgen blockade with a gonadotropin-releasing hormone agonist (4) androgen receptor blocker (1) or both (24) beginning 2 months prior to irradiation (mean follow-up 3.0 years) for a mean duration of 6 months. Two of these patients were excluded from further analysis because they received hormonal therapy for more than 1 year. Patients received a prostatic fossa dose of 60-70 Gy at 2 Gy per fraction; 48 patients also received pelvic nodal irradiation to a median dose of 50 Gy. Survival, freedom from clinical relapse (FFCR), and freedom from biochemical relapse (FFBR) were evaluated by the Kaplan-Meier method. Biochemical relapse was defined as two consecutive PSA measurements exceeding 0.07 ng/ml.
At 5 years after irradiation, actuarial survival for all patients was 92%, FFCR was 77%, and FFBR was 34%. FFBR was significantly better among patients who received transient androgen blockade before and during radiotherapy than among those treated with radiation alone (56 vs. 27% at 5 years, p = 0.004). FFCR was also superior for the combined treatment group (100 vs. 70% at 5 years, p = 0.014). Potential clinical prognostic factors before irradiation did not differ significantly between treatment groups, including tumor stage, summed Gleason histologic score, lymph node status, indication for treatment, and PSA levels before surgery or subsequent treatment. Multivariate analysis revealed that transient androgen deprivation was the only significant predictor for biochemical failure.
This retrospective study of irradiation after radical prostatectomy suggests that transient androgen blockade and irradiation may improve freedom from early biochemical and clinically evident relapse compared to radiotherapy alone, although more prolonged follow-up will be needed to assess durability of impact upon clinical recurrence and survival rates.
评估短暂雄激素剥夺疗法是否能改善局部晚期疾病、术后前列腺特异性抗原（PSA）持续升高或局部复发的患者在根治性前列腺切除术后接受放疗的疗效。
回顾了1985年8月至1995年12月期间105例接受耻骨后根治性前列腺切除术后盆腔放疗的连续患者的记录。74例患者仅接受放疗（平均随访4.6年），31例患者在放疗前2个月开始接受促性腺激素释放激素激动剂（4例）、雄激素受体阻滞剂（1例）或两者联合（24例）的短暂雄激素阻断治疗（平均随访3.0年），平均持续时间为6个月。其中2例患者因接受激素治疗超过1年而被排除在进一步分析之外。患者前列腺窝剂量为60 - 70 Gy，每次分割剂量为2 Gy；48例患者还接受盆腔淋巴结照射，中位剂量为50 Gy。采用Kaplan-Meier法评估生存率、无临床复发（FFCR）和无生化复发（FFBR）情况。生化复发定义为连续两次PSA测量值超过0.07 ng/ml。
放疗后5年，所有患者的精算生存率为92%，FFCR为77%，FFBR为34%。接受放疗前和放疗期间短暂雄激素阻断治疗的患者FFBR显著优于单纯放疗患者（5年时分别为56%和27%，p = 0.004）。联合治疗组的FFCR也更高（5年时分别为100%和70%，p = 0.014）。放疗前潜在的临床预后因素在治疗组之间无显著差异，包括肿瘤分期、Gleason组织学评分总和、淋巴结状态、治疗指征以及手术前或后续治疗前的PSA水平。多因素分析显示，短暂雄激素剥夺是生化失败的唯一显著预测因素。
这项对根治性前列腺切除术后放疗的回顾性研究表明，与单纯放疗相比，短暂雄激素阻断和放疗可能改善早期生化和临床明显复发的无病生存率，尽管需要更长时间的随访来评估对临床复发和生存率影响的持久性。
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