Patterns of Local Failure following Radiation Therapy for Prostate Cancer
Patterns of Local Failure following Radiation Therapy for Prostate Cancer
复制标题
DOI：
10.1016/j.juro.2015.04.111
复制
发表时间：
2015-10-01
影响因子：
6.6
通讯作者：
Carroll, Peter R.
中科院分区：
文献类型：
--
作者：
Jalloh, Mohamed;Leapman, Michael S.;Carroll, Peter R.
目的：对前列腺癌放射治疗后局部失败的模式知之甚少。我们的目的是描述男性生化复发患者的放疗后活检结果，包括放射治疗后复发疾病的治疗效果和区域分布。材料和方法：我们确定了因局部疾病而在初次放疗后生化复发的情况下接受放射后活检的患者。放射治疗后的组织学活检结果按无肿瘤、放射治疗效果显示、失败(复发癌症)或治疗效果和失败的组合进行分类。我们描述了组织学失败的模式，并将它们与诊断性活检结果进行了比较。结果：共有284名男性因生化复发而接受了放射后标测活检。初诊时的平均年龄为63岁，前列腺特异性抗原的中位数为8.2 ng/ml。根据前列腺癌的临床风险评估(CAPRA)分类，分别有33%、32%和35%的男性被划分为低、中和高风险。放疗后活组织检查的中位时间是治疗后61个月。4%的病例结果为阴性，而我们注意到治疗有效的占31%，失败的占45%，联合治疗的占20%。六分仪的失败率相似。在140例标测的治疗前和治疗后活检的患者中，4%的患者在以前被确定为阴性的新位置发现了癌症。43%的患者Gleason升级，85%的患者升级到4+3或更高。结论：前列腺癌放疗后前列腺特异性抗原升高的男性最常复发于优势肿瘤部位。无论失败是由于靶向、剂量或固有的辐射抵抗力不足，我们仍不清楚。有必要进行进一步的研究。
Purpose: Little is known about patterns of local failure following radiation therapy for prostate cancer. We aimed to characterize post-radiation biopsy findings, including the treatment effect and the zonal distribution of recurrent disease after radiation therapy, in men experiencing biochemical recurrence.Materials and Methods: We identified patients who received post-radiation biopsy in the setting of biochemical recurrence following primary radiation for localized disease. Histological post-radiation biopsy results were categorized by the absence of tumor, demonstration of radiation treatment effect, failure (recurrent cancer) or a combination of treatment effect and failure. We described patterns of histological failure and compared them to the diagnostic biopsy findings.Results: A total of 284 men underwent mapped post-radiation biopsy for biochemical recurrence. Mean age at initial diagnosis was 63 years and median prostate specific antigen was 8.2 ng/ml. Of the men 33%, 32% and 35% were classified at low, intermediate and high risk based on clinical CAPRA (Cancer of the Prostate Risk Assessment) categories. Median time to post-radiation biopsy was 61 months after treatment. Findings were negative in 4% of cases while we noted a treatment effect in 31%, failure in 45% and a combination in 20%. Failure rates were similar across sextants. Of 140 patients with mapped pretreatment and posttreatment biopsies 4% demonstrated cancer in a new location previously identified as negative. Gleason upgrading occurred in 43% of cases with 85% upgraded to 4 + 3 or higher.Conclusions: Men with rising prostate specific antigen after radiotherapy for prostate cancer most often experience recurrence in dominant tumor sites. Whether failure is due to inadequate targeting, dosing or intrinsic radiation resistance remains unknown to our knowledge. Further study is warranted.