Analysis of intraprostatic failures in patients treated with hormonal therapy and radiotherapy: Implications for conformal therapy planning
Analysis of intraprostatic failures in patients treated with hormonal therapy and radiotherapy: Implications for conformal therapy planning
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DOI：
10.1016/s0360-3016(02)02795-5
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发表时间：
2002-07-01
影响因子：
7
通讯作者：
Smaniotto, D
中科院分区：
文献类型：
--
作者：
Cellini, N;Morganti, AG;Smaniotto, D
目的：前列腺癌的适形治疗是以大剂量照射整个前列腺癌为基础的。本研究的目的是分析65~70Gy外照射(EBRT)治疗前列腺癌患者前列腺腔内复发的规律，以评估常规放疗剂量是否足以控制原发灶外的微观疾病，从而评价大剂量照射是否能完全集中于肉眼可见的疾病。方法与材料：分析118例前列腺癌患者接受EBRT(64.8~70.2Gy)联合激素治疗的临床和放射学报告。结果：平均随访45个月(14~119个月)，5年精算局部控制率为83.9%。12例患者有前列腺腔内复发，出现新的结节(5例治疗后完全有效)或与最小结节大小(7例)相比增大。在所有患者中，根据对复发部位的半定量评估，这被证明是起源于最初的肿瘤体积。结论：这一分析结果似乎证实了在接受前列腺切除术治疗放疗后局部复发的患者中观察到的一些组织学结果，即局部复发通常起源于原发肿瘤而不是局灶性前列腺上皮内瘤变。这一观察结果可能证明适形治疗程序的应用是合理的，目的是在增强阶段识别大体肿瘤体积，仅与原发肿瘤相关。(C)2002年爱思唯尔科学公司。
Purpose: Conformal therapy of prostate cancer is based on high-dose irradiation to the entire prostate gland. The aim of this study was to analyze the pattern of intraprostatic recurrence in patients undergoing external beam radiotherapy (EBRT) at a dose of 65-70 Gy to evaluate whether conventional radiotherapy doses are adequate to control microscopic disease outside the primary tumor and therefore whether high-dose irradiation can be exclusively focused on the macroscopic disease.Methods and Materials: The clinical and radiologic reports of 118 patients with prostate cancer undergoing EBRT (64.8-70.2 Gy) combined with hormonal therapy were evaluated. In all patients, before and after therapy, the size and site of the primary neoplasm within the prostate were assessed by clinical examination and imaging studies.Results: With a median follow-up of 45 months (range 14-119), the 5-year actuarial local control rate was 83.9%. Twelve patients had an intraprostatic recurrence, with the appearance of a new nodule (in 5 patients with a complete response after therapy) or increased nodular size compared with the minimal size (in the 7 other patients). In all patients, on the basis of a semiquantitative evaluation of the site of recurrence, this was shown to originate within the initial tumor volume.Conclusion: The results of this analysis seem to confirm some histologic findings observed in patients undergoing prostatectomy for local recurrence after radiotherapy that suggest that local recurrence usually originates in the primary tumor rather than in focal prostatic intraepithelial neoplasia. This observation might justify the application of conformal therapy procedures aimed at identifying the gross tumor volume, in the phase of boost, exclusively with the primary tumor. (C) 2002 Elsevier Science Inc.