A MATCHED CONTROL ANALYSIS OF ADJUVANT AND SALVAGE HIGH-DOSE POSTOPERATIVE INTENSITY-MODULATED RADIOTHERAPY FOR PROSTATE CANCER
A MATCHED CONTROL ANALYSIS OF ADJUVANT AND SALVAGE HIGH-DOSE POSTOPERATIVE INTENSITY-MODULATED RADIOTHERAPY FOR PROSTATE CANCER
复制标题
DOI：
10.1016/j.ijrobp.2010.04.039
复制
发表时间：
2011-08-01
影响因子：
7
通讯作者：
De Meerleer, Gert
中科院分区：
文献类型：
--
作者：
Ost, Piet;De Troyer, Bart;De Meerleer, Gert
目的：目前尚不清楚前列腺切除术中高危疾病（包膜穿孔、精囊浸润和/或手术切缘阳性）的立即辅助放疗是否等同于生化复发时的延迟补救放疗。我们进行了一项匹配病例分析，比较了高剂量辅助调强放疗（A-IMRT）与补救性调强放疗（S-IMRT）。144名在乳腺癌切除术时患有高危疾病的患者接受了A-IMRT，134名患有高危疾病的患者在生化复发时接受了A-IMRT（前列腺特异性抗原[PSA]升高，前列腺切除术后，高于0.2 ng/ml）。根据术前PSA水平、Gleason评分和pT分期，患者按1：1比例匹配。A-IMRT和S-IMRT的中位剂量分别为74戈伊和76戈伊。我们使用Kaplan-Meier方法报告生化无复发生存率（bRFS）。单变量和多变量分析被用来检查肿瘤和治疗相关factors.Results：共178例患者匹配（89：89）。从放疗结束后，两组的中位随访时间为36个月。A-IMRT组的3年bRFS率为90%，而S-IMRT组为65%（p < 0.05）。多变量分析显示，S-IMRT、Gleason分级>= 4+3、神经周围浸润、术前PSA水平>= 10 ng/ml和未行雄激素剥夺（AD）是bRFS降低的独立预测因素（p < 0.05）。从手术之日起，A-IMRT和S-IMRT的中位随访时间分别为43个月和60个月。A-IMRT的3年bRFS率为91%，而S-IMRT为79%（p < 0.05）。在多变量分析中，Gleason分级>= 4+3、神经周围浸润和AD的遗漏是bRFS降低的独立预测因素（p < 0.05）。S-IMRT不再是一个独立的预后因素（p = 0.08）。结论：与S-IMRT相比，高剂量A-IMRT显著改善了3年bRFS。Gleason分级>= 4+3的神经周围浸润和AD的遗漏是bRFS降低的独立预后因素，无论是手术日期还是放疗日期。(C)2011 Elsevier Inc.
Purpose: It is unclear whether immediate adjuvant radiotherapy for high-risk disease at prostatectomy (capsule perforation, seminal vesicle invasion, and/or positive surgical margins) is equivalent to delayed salvage radiotherapy at biochemical recurrence. We performed a matched case analysis comparing high-dose adjuvant intensity modulated radiotherapy (A-IMRT) with salvage IMRT (S-IMRT).Methods and Materials: One hundred forty-four patients with high-risk disease at prostatectomy were referred for A-IMRT, and 134 patients with high-risk disease were referred at biochemical recurrence (rising prostate-specific antigen [PSA], following prostatectomy, above 0.2 ng/ml) for S-IMRT. Patients were matched in a 1:1 ratio according to preoperative PSA level, Gleason score, and pT stage. Median doses of 74 Gy and 76 Gy were prescribed for A-IMRT and S-IMRT, respectively. We report biochemical relapse free survival (bRFS) rates using the Kaplan-Meier method. Univariate and multivariate analyses were used to examine tumour- and treatment-related factors.Results: A total of 178 patients were matched (89:89). From the end of radiotherapy, the median follow-up was 36 months for both groups. The 3-year bRFS rate for the A-IMRT group was 90% compared to 65% for the S-IMRT group (p < 0.05). On multivariate analysis, S-IMRT, Gleason grades of >= 4+3, perineural invasion, preoperative PSA level of >= 10 ng/ml, and omission of androgen deprivation (AD) were independent predictors for a reduced bRFS (p < 0.05). From the date of surgery, the median follow-up was 43 and 60 months for A-IMRT and S-IMRT, respectively. The 3-year bRFS rate for A-IMRT was 91% compared to 79% for S-IMRT (p < 0.05). On multivariate analysis, Gleason grades of >= 4+3, perineural invasion, and omission of AD were independent predictors for a reduced bRFS (p < 0.05). S-IMRT was no longer an independent prognostic factor (p = 0.08).Conclusions: High-dose A-IMRT significantly improves 3-year bRFS compared to S-IMRT. Gleason grades of >= 4+3 perineural invasion, and omission of AD were independent prognostic factors for a decreased bRFS, both from the dates of surgery and from radiotherapy. (C) 2011 Elsevier Inc.