Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer
Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer
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DOI：
10.1016/s0360-3016(97)00080-1
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发表时间：
1997-07-01
影响因子：
7
通讯作者：
Shipley, WU
中科院分区：
文献类型：
--
作者：
Morris, MM;Dallow, KC;Shipley, WU
目的：我们进行了一项回顾性分析，以评估pT3NO疾病的直肠切除术后放射治疗的持久性和治愈的可能性。方法和材料：我们研究了88名患者，他们在前列腺切除术后接受了放射治疗，并且有可用的前列腺特异性抗原（PSA）数据，没有已知的淋巴结或转移性疾病，没有激素治疗，并且从手术开始随访至少12个月，40例患者因PSA检测不到而接受了局部失败高风险的辅助治疗，48例患者因PSA水平升高而接受了挽救治疗，平均随访时间为手术后44个月和放疗后31个月，生化失败严格定义为PSA升高> 10%，或作为检测以前无法检测的PSA值的能力。结果：挽救性放疗后，69%的患者达到了不可检测的PSA，88%的辅助患者在膀胱切除术后3年时生化和临床上无疾病（bNED），接受挽救性放疗的患者中，68%在术后3年发生bNED，单因素分析显示，治疗组（辅助或挽救）、术前PSA和精囊状态是重要的预后因素，在挽救组中PSA升高的程度也是显著的，我们没有证明那些PSA持续升高的挽救患者与那些PSA晚期升高的患者之间存在显著差异。在多变量分析中，唯一有意义的预后预测因素是治疗组，辅助放疗的预后优于挽救治疗。超过三分之二的这组患者在照射后3年内仍然没有生化疾病，证明了一些潜在的治愈，对于根治性前列腺切除术后的pT3NO期前列腺癌患者，我们的数据支持使用常规术后辅助放疗或密切PSA随访和早期挽救治疗。(C)1997年爱思唯尔科学公司
Purpose: We performed a retrospective analysis to assess the durability of benefit derived from irradiation after prostatectomy for pT3NO disease, and the possibility of cure.Methods and Materials: We studied 88 patients who were irradiated after prostatectomy and had available prostate specific antigen (PSA) data, no known nodal or metastatic disease, no hormonal treatment, and follow-up of at least 12 months from surgery, Forty patients received adjuvant therapy for a high risk of local failure with undetectable PSA, Forty-eight patients received salvage therapy for elevated PSA levels, Mean follow up was 44 months from date of surgery and 31 months from irradiation, Biochemical failure was strictly defined as a confirmed rise in PSA of >10%, or as the ability to detect a previously undetectable PSA value.Results: After salvage irradiation, 69% of patients attained an undetectable PSA, Eighty-eight percent of adjuvant patients were biochemically and clinically free of disease (bNED) at 3 years from prostatectomy, Sixty-eight percent of those receiving salvage irradiation were bNED 3 years after surgery, On univariate analysis, treatment group (adjuvant or salvage), pre-operative PSA, and the status of seminal vesicles were significant prognostic factors, The extent of PSA elevation in the salvage group was also significant, We did not demonstrate a significant difference between those salvage patients referred for persistently elevated PSA as compared to those with a late rise in PSA, On multivariate analysis, the only significant predictor of outcome was treatment group, with adjuvant irradiation having better outcome than salvage.Conclusion: More than two-thirds of this group of patients remain biochemically disease free at 3 years following irradiation, attesting to a number of potential cures, For patients with stage pT3NO prostate cancer following radical prostatectomy, our data support the use of either routine postoperative adjuvant irradiation or close PSA follow-up with early salvage treatment. (C) 1997 Elsevier Science Inc.