Seaward S A, Weinberg V, Lewis P, Leigh B, Phillips T L, Roach M
Department of Radiation Oncology, University of California, San Francisco Medical Center, USA.
Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):1055-62. doi: 10.1016/s0360-3016(98)00282-x.
To determine the impact of whole pelvic irradiation on the risk of PSA failure in prostate cancer patients, at high predicted risk for lymph node involvement, receiving definitive radiotherapy.
Between October 1987 and December 1995, 506 patients with clinically localized prostate cancer were treated with definitive radiotherapy at UCSF and affiliated institutions. Treatment consisted of 4-field whole pelvic irradiation followed by a prostate-only boost, or prostate-only treatment (median follow-up was 35 months and 30 months, respectively). PSA failure was defined as: 1. a PSA value > or = 1 ng/ml; or 2. a PSA value that rose > or = 0.5 ng/ml in < or = 1 year posttreatment on two consecutive measurements, with the first rise defined as the time of failure. The calculated risk of lymph node positivity (%rLN+) was defined as 2/3(iPSA) + 10(GS-6), and high risk was defined as %rLN+ > or = 15%. Univariate and multivariate analyses were performed.
A total of 201 high-risk patients were identified. High-risk patients who received whole pelvic irradiation had significantly improved freedom from PSA failure compared to those who received prostate-only treatment (median PFS = 34.3 months vs. 21.0 months; p = 0.0001). Potential confounding variables, including initial PSA, Gleason score, T stage, radiation dose, year of treatment, use of three-dimensional (3D) conformal techniques, and use of hormone therapy, did not account for the observed difference in time to PSA failure. Multivariate analysis revealed type of radiation treatment to be the most significant independent predictor of outcome.
Whole pelvic radiotherapy significantly improves the PSA failure-free survival in patients with a high calculated risk of lymph node positivity.
确定全盆腔照射对前列腺癌患者前列腺特异性抗原（PSA）失败风险的影响，这些患者有较高的淋巴结受累预测风险且接受根治性放疗。
1987年10月至1995年12月期间，506例临床局限性前列腺癌患者在加州大学旧金山分校及其附属机构接受了根治性放疗。治疗包括四野全盆腔照射，随后进行仅前列腺区的加量照射，或仅前列腺区治疗（中位随访时间分别为35个月和30个月）。PSA失败定义为：1. PSA值≥1 ng/ml；或2. 治疗后1年内连续两次测量PSA值升高≥0.5 ng/ml，首次升高定义为失败时间。计算的淋巴结阳性风险（%rLN+）定义为2/3（初始PSA）+10（ Gleason评分-6），高风险定义为%rLN+≥15%。进行了单因素和多因素分析。
共确定201例高风险患者。与仅接受前列腺区治疗的患者相比，接受全盆腔照射的高风险患者无PSA失败的自由度显著提高（中位无进展生存期=34.3个月对vs . 21.0个月；p = 0.0001）。潜在的混杂变量包括初始PSA、Gleason评分、T分期、放射剂量、治疗年份、三维（3D）适形技术的使用以及激素治疗的使用，均不能解释观察到的PSA失败时间差异。多因素分析显示放射治疗类型是结果的最显著独立预测因素。
全盆腔放疗显著提高了淋巴结阳性计算风险高的患者的无PSA失败生存期。
