Salvage or Adjuvant Radiation Therapy: Counseling Patients on the Benefits
Salvage or Adjuvant Radiation Therapy: Counseling Patients on the Benefits
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DOI：
10.6004/jnccn.2010.0015
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发表时间：
2010-02-01
影响因子：
13.4
通讯作者：
Walsh, Patrick C.
中科院分区：
文献类型：
--
作者：
Nielsen, Matthew E.;Trock, Bruce J.;Walsh, Patrick C.
泌尿系肿瘤学文献的最新进展表明，与手术时存在的隐匿性转移灶相比，局部残留病变可能是最初临床局限性前列腺癌复发和进展的自然史中更重要的组成部分。这些重要的研究已经阐明了术后放疗（RT）对具有不良病理特征（前列腺外扩展、精囊浸润或手术切缘阳性）或根治性前列腺切除术后生化复发的患者的获益程度。然而，是否所有具有上述不良特征的患者都应接受立即辅助RT，而不是在生化失败的情况下进行更具选择性的早期补救RT的初始观察，这一问题仍然是激烈争论的主题。本文回顾了最近在这一领域的突出研究，以解决重要的问题，咨询患者使用后直肠切除术RT。讨论点包括数据支持的好处（疗效），问题的普遍性的好处（有效性）和风险，以及进一步研究的重要问题。（JNCCN 2010; 8：228-237）
Recent developments in the urologic oncology literature suggest that residual local disease-as opposed to the presence of occult metastases at surgery-may characterize a more substantial component of the natural history of the recurrence and progression of initially clinically localized prostate cancer than previously appreciated. These important studies have illuminated the extent to which postoperative radiotherapy (RT) may provide benefit to patients with adverse pathologic features (extraprostatic extension, seminal vesicle invasion, or positive surgical margins) or biochemical recurrence after radical prostatectomy. Nevertheless, the question of whether all patients with the aforementioned adverse features should undergo immediate adjuvant RT versus initial observation with more selective-but early-salvage RT in the event of biochemical failure remains the subject of heated controversy. This article reviews salient recent studies in this field to address important questions relevant to counseling patients on the use of post prostatectomy RT. Discussion points include data supporting benefit (efficacy), questions of generalizability of benefit (effectiveness) and risks, and important questions for further study. (JNCCN 2010; 8:228-237)