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首页> 外文期刊>Urologic oncology >Salvage radiation for a rising PSA following radical prostatectomy.
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Salvage radiation for a rising PSA following radical prostatectomy.

机译：根治性前列腺切除术后PSA升高的抢救性放射。

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The purpose of this study was to evaluate the efficacy and complications of postprostatectomy therapeutic irradiation (RT) in patients with known residual disease. Between 1991 and 2003, 170 patients received therapeutic irradiation for a rising PSA following radical prostatectomy. No patients had clinical or radiological evidence of metastatic disease. The median pre-RT PSA level was 1.2 ng/mL (range, 0.2-43 ng/mL). During irradiation, the PSA level was checked weekly (median PSA determinations: 5, range, 2-7). A patient was considered to have a rise/fall of PSA if the level changed by > or = 0.2 ng/mL. There were 149 patients who received photon irradiation (median dose, 6800 cGy) and 21 patients received a combination of photon and neutron irradiation to a median photon dose equivalent of 7800 cGy. A patient was considered to have biochemical failure if his PSA level postnadir was measured at >0.2 ng/mL. Complications were graded according to the RTOG toxicity scale. The median follow-up time was 49months (range, 1-137 months). Sixty-four patients (38%) had evidence of biochemical failure. The 7 year overall survival was 84%. At 7 years, the actuarial biochemical relapse free survival (bRFS) was 44%. Of the 59 patients with a preradiation PSA <1 ng/mL, the 5 year bRFS was 81%. This compares with 45% for both the PSA 1-4 and PSA >4 ng/mL group (P = 0.00008). The 3-year bRFS rates for patients whose PSA levels increased, decreased, and remained the same during radiation were 20%, 65%, and 76%, respectively (P = 0.0005). Overall survival at 7 years in the decreased PSA group was 88% compared to 67% for those whose PSA level increased (P = 0.43). Thirty-three percent and 19% of the patients experienced Grade 2 genitourinary (GU) and gastrointestinal (GI) complications, respectively. Six percent and 3% of the patients had Grade 3 GU and GI complications, respectively. On univariate and multivariate analysis, the factors significantly associated with a favorable outcome were a declining PSA during RT and a pre-RT PSA <1 ng/mL (P < 0.001). Radiation therapy is an effective treatment modality for select patients with a biochemical recurrence following radical prostatectomy. Patients with a low preradiation PSA level (<1.0 ng/mL) had a significantly better outcome, which supports the early use of therapeutic radiation. The observation that patients with a rising PSA level during treatment do poorly supports the routine practice of monitoring these levels during radiotherapy.
机译：这项研究的目的是评估前列腺癌切除术后治疗性放疗（RT）在已知残留疾病患者中的疗效和并发症。在1991年至2003年之间，有170例患者接受了根治性前列腺切除术后PSA升高的放射治疗。没有患者有转移性疾病的临床或放射学证据。 RT前PSA的中位数为1.2 ng / mL（范围0.2-43 ng / mL）。辐照期间，每周检查一次PSA水平（中位PSA测定值：5，范围2-7）。如果水平改变>或= 0.2 ng / mL，则认为患者的PSA升高/降低。有149位患者接受了光子辐照（中位剂量为6800 cGy），有21位患者接受了光子和中子的联合辐照，中位光子剂量相当于7800 cGy。如果患者的血浆PSA水平在最低点> 0.2 ng / mL，则被视为生化失败。根据RTOG毒性量表对并发症进行分级。中位随访时间为49个月（范围1-137个月）。六十四名患者（38％）有生化失败的证据。 7年总生存率为84％。在7年时，精算生化无复发生存率（bRFS）为44％。在59例预辐射PSA <1 ng / mL的患者中，5年bRFS为81％。相比之下，PSA 1-4和PSA> 4 ng / mL组的患病率均为45％（P = 0.00008）。 PSA水平升高，降低和在放射期间保持不变的患者的3年bRFS发生率分别为20％，65％和76％（P = 0.0005）。 PSA降低组的7年总生存率为88％，而PSA水平升高的组为67％（P = 0.43）。分别有33％和19％的患者发生2级泌尿生殖系统（GU）和胃肠道（GI）并发症。分别有6％和3％的患者患有3级GU和GI并发症。单因素和多因素分析显示，与预后良好相关的显着因素是放疗期间PSA下降和放疗前PSA <1 ng / mL（P <0.001）。对于根治性前列腺切除术后生化复发的部分患者，放射疗法是一种有效的治疗方式。放射前PSA水平低（<1.0 ng / mL）的患者预后明显好转，这支持早期使用治疗性放射。患者在治疗过程中PSA水平升高的观察结果不佳，这支持在放射治疗期间监测这些水平的常规做法。

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