Long-Term Outcomes After High-Dose Postprostatectomy Salvage Radiation Treatment
Long-Term Outcomes After High-Dose Postprostatectomy Salvage Radiation Treatment
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DOI：
10.1016/j.ijrobp.2011.10.077
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发表时间：
2012-09-01
影响因子：
7
通讯作者：
Zelefsky, Michael J.
中科院分区：
文献类型：
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作者：
Goenka, Anuj;Magsanoc, Juan Martin;Zelefsky, Michael J.
目的：回顾高剂量放疗（RT）在根治性乳腺癌切除术后的补救设置长期生化控制和远处转移瘤无生存的影响，并确定临床和病理预测outcomes.Methods和材料：在1988-2007年，285例连续患者进行了根治性乳腺癌切除术后的补救RT（SRT）。所有患者均接受三维适形放疗或调强放疗。270例患者（95%）接受了≥ 66戈伊的剂量治疗，其中205例（72%）接受了≥ 70戈伊的剂量治疗。87例患者（31%）接受雄激素剥夺治疗作为其挽救治疗的一部分。所有的临床和病理记录进行了审查，以确定治疗的危险因素和respons.Results：SRT后的中位随访时间为60个月。7年前列腺特异性抗原（PSA）无复发生存率和无远处转移生存率分别为37%和77%。生化复发的独立预测因素为血管侵犯（p < 0.01）、手术切缘阴性（p < 0.01）、龈前PSA水平>0.4 ng/mL（p < 0.01）、雄激素剥夺治疗（p = 0.03）、Gleason评分≥ 7（p = 0.02）和精囊受累（p = 0.05）。挽救RT剂量>= 70戈伊与生化控制改善无关。倍增时间< 3个月是转移性疾病的唯一独立预测因素（p < 0.01）。有一种趋势表明，SRT剂量>= 70戈伊在预防临床局部失败的患者在放射学上可见的局部疾病在SRT（7年：90%对79.1%，p = 0.07）。结论：挽救RT提供了有效的长期生化控制和自由转移的选定患者与可检测的PSA后乳腺癌切除术。雄激素剥夺治疗与生化无进展生存期的改善相关。临床局部失败罕见，但最常见于SRT时疾病负担较大的患者，如放射学成像或PSA水平较高所反映。挽救性放射剂量>= 70戈伊可能最终对这些患者最有益，但这需要进一步研究。(C)2012 Elsevier Inc.
Purpose: To review the impact of high-dose radiotherapy (RT) in the postprostatectomy salvage setting on long-term biochemical control and distant metastases-free survival, and to identify clinical and pathologic predictors of outcomes.Methods and Materials: During 1988-2007, 285 consecutive patients were treated with salvage RT (SRT) after radical prostatectomy. All patients were treated with either three-dimensional conformal RT or intensity-modulated RT. Two hundred seventy patients (95%) were treated to a dose >= 66 Gy, of whom 205 (72%) received doses >= 70 Gy. Eighty-seven patients (31%) received androgen-deprivation therapy as a component of their salvage treatment. All clinical and pathologic records were reviewed to identify treatment risk factors and response.Results: The median follow-up time after SRT was 60 months. Seven-year actuarial prostate-specific antigen (PSA) relapse-free survival and distant metastases-free survival were 37% and 77%, respectively. Independent predictors of biochemical recurrence were vascular invasion (p < 0.01), negative surgical margins (p < 0.01), presalvage PSA level >0.4 ng/mL (p < 0.01), androgen-deprivation therapy (p = 0.03), Gleason score >= 7 (p = 0.02), and seminal vesicle involvement (p = 0.05). Salvage RT dose >= 70 Gy was not associated with improvement in biochemical control. A doubling time < 3 months was the only independent predictor of metastatic disease (p < 0.01). There was a trend suggesting benefit of SRT dose >= 70 Gy in preventing clinical local failure in patients with radiographically visible local disease at time of SRT (7 years: 90% vs. 79.1%, p = 0.07).Conclusion: Salvage RT provides effective long-term biochemical control and freedom from metastasis in selected patients presenting with detectable PSA after prostatectomy. Androgen-deprivation therapy was associated with improvement in biochemical progression-free survival. Clinical local failures were rare but occurred most commonly in patients with greater burden of disease at time of SRT as reflected by either radiographic imaging or a greater PSA level. Salvage radiation doses >= 70 Gy may ultimately be most beneficial in these patients, but this needs to be further studied. (C) 2012 Elsevier Inc.