3D conformal radiation therapy (3DCRT) for high grade prostate cancer: A multi-institutional review
3D conformal radiation therapy (3DCRT) for high grade prostate cancer: A multi-institutional review
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DOI：
10.1016/s0360-3016(00)00441-7
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发表时间：
2000-05-01
影响因子：
7
通讯作者：
Sandler, HM
中科院分区：
文献类型：
--
作者：
Fiveash, JB;Hanks, G;Sandler, HM
目的：为了评估3DCRT的结果以及高级别前列腺癌患者中高于传统剂量的效果，我们收集了来自三个机构的数据，并分析了这一相对罕见的前列腺癌患者子集的结果。方法和材料：180例Gleason评分为8-10的前列腺癌患者在密歇根大学卫生系统接受了3BCRT治疗，加州大学旧金山弗朗西斯科，或福克斯蔡斯癌症中心。符合条件的患者患有T1-T4 NO或NX MO腺癌，治疗前PSA。治疗前特征包括：中位年龄72岁，60.6%的Gleason评分8肿瘤，57.6% T1-T2，中位治疗前PSA 17.1 ng/ml（范围0.3-257.1）。33%的患者接受的总剂量为75戈伊; 27%的患者接受了辅助或新辅助激素治疗。所有患者的中位随访时间为3.0年，16%的患者随访至少5年。结果：所有患者的5年无PSA失败率为62.5%，T1-T2患者为79.3%。单变量分析显示，T分期（T1-T2 vs. T3-T4）、治疗前PSA和RT剂量可预测无PSA失败。所有患者的5年总生存率为67.3%。单变量分析显示，仅RT剂量可预测5年总生存率。由于T分期和RT剂量之间存在显著相关性，因此分别对T1-T2和T3-T4肿瘤进行了考克斯比例风险模型。对于T3-T4患者的总生存率或无PSA失败率或T1-T2患者的总生存率，没有任何预后因素达到统计学显著性。低RT剂量和较高的治疗前PSA预测PSA失败的多变量分析在T1-T2 patients.Conclusion：这一回顾性研究从三个机构的经验，在剂量递增表明，剂量效应PSA控制在70戈伊以上的T1-T2高级别前列腺癌患者。这些结果上级于手术，并强调了在治疗Gleason 8-10前列腺癌中需要剂量递增。(C)2000 Elsevier Science Inc.
Purpose: To evaluate the results of 3DCRT and the effect of higher than traditional doses in patients with high grade prostate cancer, we compiled data from three institutions and analyzed the outcome of this relatively uncommon subset of prostate cancer patients.Methods and Materials: The 180 patients with Gleason score 8-10 adenocarcinoma of the prostate were treated with 3BCRT at the University of Michigan Health System, University of California-San Francisco, or Fox Chase Cancer Center. Eligible patients had T1-T4 NO or NX MO adenocarcinoma with a pretreatment PSA. Pretreatment characteristics included: median age 72 years, 60.6% Gleason score 8 tumors, 57.6% T1-T2, and median pretreatment PSA 17.1 ng/ml (range 0.3-257.1). The total dose received was 75 Gy in 33%; 27% received adjuvant or neoadjuvant hormonal therapy. The median follow-up was 3.0 years for all patients and 16% of patients were followed up for at least 5 years.Results: The 5-year freedom from PSA failure was 62.5% for all patients and 79.3% in T1-T2 patients. Univariate analysis revealed that T-stage (T1-T2 vs. T3-T4), pretreatment PSA, and RT dose predicted for freedom from PSA failure. A 5-year overall survival for all patients was 67.3%. Only RT dose was predictive of 5-year overall survival on univariate analysis. Because a significant association was seen between T-stage and RT dose, the Cox proportional hazards model was performed separately for T1-T2 and T3-T4 tumors. None of the prognostic factors reached statistical significance for overall survival or freedom from PSA failure in T3-T4 patients or for overall survival in T1-T2 patients. Lower RT dose and higher pretreatment PSA predicted for PSA failure on multivariate analysis in T1-T2 patients.Conclusion: This retrospective study from three institutions with experience in dose escalation suggests a dose effect for PSA control above 70 Gy in patients with T1-T2 high grade prostate cancer. These results are superior to surgery and emphasize the need for dose escalation in treating Gleason 8-10 prostate cancer. (C) 2000 Elsevier Science Inc.