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首页> 外文期刊>European urology >High-dose salvage intensity-modulated radiotherapy with or without androgen deprivation after radical prostatectomy for rising or persisting prostate-specific antigen: 5-year results.
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High-dose salvage intensity-modulated radiotherapy with or without androgen deprivation after radical prostatectomy for rising or persisting prostate-specific antigen: 5-year results.

机译：根治性前列腺切除术后大剂量抢救强度调节放疗，伴或不伴雄激素剥夺，用于前列腺特异性抗原升高或持续存在：5年结果。

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BACKGROUND: Long-term results with salvage radiotherapy (SRT) for a biochemical recurrence after radical prostatectomy (RP) are poor. It has been suggested that radiotherapy doses >70 Gy might result in improved outcome. OBJECTIVE: To report on the late toxicity profile and outcome of patients treated with high-dose salvage intensity-modulated radiotherapy (HD-SIMRT) with or without androgen deprivation (AD). DESIGN, SETTING, AND PARTICIPANTS: Between 1999 and 2008, 136 patients were referred for HD-SIMRT with or without AD. The median follow-up was 5 yr. Indications for HD-SIMRT were persisting prostate-specific antigen (PSA) or a rising PSA following RP. All patients were irradiated at a single, tertiary, academic centre. AD was initiated on the basis of seminal vesicle invasion, preprostatectomy PSA >20 ng/ml, Gleason score >/= 4+3 (n=43), or personal preference of the referring urologist (n=54). INTERVENTION: A median 76-Gy dose was prescribed to the RP bed using intensity-modulated radiotherapy (IMRT) in all patients. AD consisted of a luteinising hormone-releasing hormone analogue for 6 mo. MEASUREMENTS: Univariate and multivariate analyses were used to examine the influence of patient- and treatment-related factors on late toxicity, biochemical relapse-free survival (bRFS), and clinical relapse-free survival (cRFS). RESULTS AND LIMITATIONS: The 5-yr actuarial bRFS and cRFS were 56% and 86%, respectively. On multivariate analysis, the presence of perineural invasion at RP (hazard ratio [HR]: 6.19, p=0.001) and an increasing pre-SRT PSA (PSA 0.5 ng/ml: HR: 1; PSA 1-1.5 ng/ml: HR: 1.60, p=0.30; and PSA >1 ng/ml: HR: 2.70, p=0.02) were independent factors for a decreased bRFS. The addition of AD improved bRFS (HR: 0.33, p=0.005). On multivariate analysis, none of the variables was a predictor of cRFS. The 5-yr risk of grade 2-3 toxicity was 22% and 8% for genitourinary and gastrointestinal symptoms, respectively. CONCLUSIONS: IMRT allows for safe dose escalation to 76Gy with good bRFS.
机译：背景：根治性前列腺切除术（RP）后使用挽救性放疗（SRT）进行生化复发的长期效果不佳。有人建议放疗剂量> 70 Gy可能会改善预后。目的：报道高剂量抢救强度调节放疗（HD-SIMRT）伴或不伴雄激素剥夺（AD）患者的晚期毒性反应和结果。设计，地点和参与者：在1999年至2008年之间，有136例患者接受了有或没有AD的HD-SIMRT治疗。中位随访时间为5年。 HD-SIMRT的指征是持续存在前列腺特异性抗原（PSA）或RP后PSA升高。所有患者均在单一的三级学术中心接受辐照。根据精囊侵袭，前列腺切除术前PSA> 20 ng / ml，格里森评分> / = 4 + 3（n = 43）或推荐泌尿科医师的个人偏爱（n = 54）来开始AD。干预：所有患者均使用强度调节放疗（IMRT）向RP床开出76 Gy的中位剂量。 AD由促黄体激素释放激素类似物持续6个月组成。测量：单因素和多因素分析用于检查患者和治疗相关因素对晚期毒性，生化无复发生存率（bRFS）和临床无复发生存率（cRFS）的影响。结果与局限性：5年期精算bRFS和cRFS分别为56％和86％。在多变量分析中，RP存在神经周围浸润（危险比[HR]：6.19，p = 0.001），SRT前PSA升高（PSA 0.5 ng / ml：HR：1; PSA 1-1.5 ng / ml： HR：1.60，p = 0.30; PSA> 1 ng / ml：HR：2.70，p = 0.02）是导致bRFS降低的独立因素。 AD的添加改善了bRFS（HR：0.33，p ＝ 0.005）。在多变量分析中，所有变量都不是cRFS的预测因子。对于泌尿生殖系统和胃肠道症状，发生2-3级毒性的5年风险分别为22％和8％。结论：IMRT可使bRFS良好的患者安全剂量增加至76Gy。

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