Salvage radiotherapy after radical prostatectomy for prostate adenocarcinoma: Analysis of efficacy and prognostic factors
Salvage radiotherapy after radical prostatectomy for prostate adenocarcinoma: Analysis of efficacy and prognostic factors
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DOI：
10.1016/s0090-4295(02)01540-6
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发表时间：
2002-05-01
期刊：
影响因子：
2.1
通讯作者：
Shipley, WU
中科院分区：
文献类型：
--
作者：
Chawla, AK;Thakral, HK;Shipley, WU
目标.确定接受挽救性放疗的患者生化控制的可能性，并确定与成功挽救相关的预后因素。根治性前列腺切除术后前列腺特异性抗原（PSA）水平升高的前列腺癌患者的最佳治疗方法尚不清楚。我们回顾了1991年至1998年期间54例单纯放疗的淋巴结阴性前列腺癌患者的记录，这些患者在前列腺切除术后发生了孤立的生化复发。中位术前PSA水平为15 ng/mL，中位挽救PSA水平为1.3 ng/mL。记录完整的病理信息，以及术后PSA失败的时间间隔。使用适当的技术对前列腺窝进行放射治疗。主要终点是生化失败，从放疗开始到首次检测到PSA水平。生化控制率采用Kaplan-Meier法测定。中位随访时间为45个月。初始完全缓解率为76%。只有精囊腺状态对初始完全缓解率具有临界意义，5年的精确生化控制率为35%。存在精囊浸润、Gleason评分大于6、术后立即检测到PSA水平均预示着5年生化控制下降。Gleason评分和可检测的术后PSA在多变量分析中保持显著性。PSA挽救水平≤ 1.2 ng/mL的患者5年生化控制率有下降趋势（P = 0.07）。挽救性放疗产生76%的完全缓解率，其中35%的治疗患者在5年时未检测到PSA。那些具有良好的生物化学和病理学肿瘤特征的人最有可能保持无疾病。(C)2002年，Elsevier Science Inc.
Objectives. To determine the probability of biochemical control for patients treated with salvage irradiation and identify prognostic factors associated with successful salvage. The optimal management of prostate cancer in patients with an elevated prostate-specific antigen (PSA) level after radical prostatectomy remains unclear.Methods. We reviewed the records of 54 patients with node-negative prostate cancer treated with radiotherapy alone between 1991 and 1998 for isolated biochemical relapse after prostatectomy. The median preoperative PSA level was 15 ng/mL, and the median salvage PSA level was 1.3 ng/mL. Complete pathologic information was recorded, as was the interval to postoperative PSA failure. Radiotherapy was delivered to the prostatic fossa using appropriate techniques. The primary endpoint was biochemical failure, measured from radiotherapy initiation to the first detectable PSA level. Biochemical control rates were determined using Kaplan-Meier methods. The median follow-up was 45 months.Results. The initial complete response rate was 76%. Only seminal vesicle status demonstrated borderline significance for the rate of the initial complete response, The 5-year actuarial biochemical control rate was 35%. The presence of seminal vesicle invasion, Gleason score greater than 6, and an immediately detectable postoperative PSA level all predicted for decreased 5-year biochemical control. Gleason score and detectable postoperative PSA retained significance on multivariate analysis. Those with a salvage PSA level of 1.2 ng/mL or less had a trend toward a decreased 5-year biochemical control rate (P = 0.07).Conclusions. Salvage radiotherapy yields a 76% complete response rate, with 35% of treated patients free of a detectable PSA at 5 years. Those with favorable biochemical and pathologic tumor features are most likely to remain disease free. (C) 2002, Elsevier Science Inc.