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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Salvage intensity-modulated radiotherapy for rising PSA after radical prostatectomy.
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Salvage intensity-modulated radiotherapy for rising PSA after radical prostatectomy.

机译：根治性前列腺切除术后抢救强度调节放疗可提高PSA。

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INTRODUCTION: The aim was to prospectively evaluate both acute and late toxicity and biochemical non-evidence of disease (bNED) in patients treated with salvage intensity-modulated radiotherapy (IMRT) +/- androgen deprivation (AD) for biochemical relapse after radical prostatectomy (RP). MATERIALS AND METHODS: IMRT was prescribed to a mean prescription dose to the planning target volume (PTV) of 75 Gy to be delivered in 37 fractions of 2 Gy. In total, 135 patients were treated with IMRT. Median age was 64 years. Median PSA level was 0.8 ng/ml. AD was initiated in 94 patients. Indications were perineural invasion, seminal vesicle invasion or Gleason score > or = 8 at RP. (1) Acute toxicity (n = 135). All patients were available for this analysis. Acute toxicity was scored using an in-house developed scoring system. (2) Late toxicity (n = 68). Only patients with a follow-up of at least 18 months were considered for late toxicity analysis. The RILIT score was used to register gastro-intestinal (GI) toxicity. An in-house developed scale was used to register genito-urinary (GU) toxicity. (3) bNED (n = 87). For bNED, all AD-naive patients (n = 38) together with the AD-positive patients with a follow-up > or = 18 months (n = 49) were considered. Factors influencing the results of salvage treatment were analyzed. RESULTS: (1) Acute toxicity (n = 135). No patient developed grade 3 GI toxicity. We observed grade 2 toxicity in 20 patients. Four patients developed grade 3 GU toxicity. (2) Late toxicity (n = 68). One patient developed grade 3 rectal blood loss. One patient developed grade 3 anal pain (anal fissure). We observed grade 2 GI toxicity in 9 patients. Two patients developed grade 3GU toxicity. Twenty-one patients developed grade 2 GU toxicity. We observed an urethral stricture in 5 patients. (3) bNED (n = 87). The 3- and 5-year bNED was 67%. Gleason score at RP, perineural invasion and capsular perforation were significant predictors for bNED. PSA before IMRT (<1.0 vs. 1.0 ng/ml) showed a trend in predicting bNED (p = 0.08). CONCLUSION: IMRT to 75Gy+/-AD can be delivered with low levels of acute and late toxicity. In patients without perineural invasion and capsular invasion and with a Gleason score > or = 7 (3 + 4), IMRT offers very good 5-years bNED.
机译：简介：目的是前瞻性评估接受挽救强度调节放疗（IMRT）+/-雄激素剥夺（AD）治疗的前列腺癌根治术后生化复发的急性和晚期毒性以及疾病的生化非证据性疾病（bNED）（ RP）。材料与方法：IMRT的处方剂量为计划目标体积（PTV）的75 Gy，将以37 Gy的2 Gy分数进行输送。共有135例患者接受了IMRT治疗。中位年龄为64岁。 PSA中位数为0.8 ng / ml。 94例患者开始AD。指征是神经周浸润，精囊浸润或RP时Gleason评分>或= 8。 （1）急性毒性（n = 135）。所有患者均可用于该分析。使用内部开发的评分系统对急性毒性进行评分。 （2）后期毒性（n = 68）。仅对随访至少18个月的患者进行后期毒性分析。 RILIT分数用于记录胃肠道（GI）毒性。内部开发的量表用于记录生殖泌尿（GU）毒性。 （3）bNED（n = 87）。对于bNED，考虑所有未接受过AD治疗的患者（n = 38）以及随访≥18个月（n = 49）的AD阳性患者。分析了影响抢救治疗结果的因素。结果：（1）急性毒性（n = 135）。没有患者出现3级胃肠道毒性。我们在20例患者中观察到2级毒性。 4名患者发生3级GU毒性。 （2）后期毒性（n = 68）。一名患者发生了3级直肠失血。一名患者出现了3级肛门疼痛（肛裂）。我们在9例患者中观察到2级胃肠道毒性。两名患者出现3GU级毒性。 21名患者发生2级GU毒性。我们观察到5例尿道狭窄。 （3）bNED（n = 87）。 3年和5年期bNED为67％。 RP，神经周围浸润和包膜穿孔的格里森评分是bNED的重要预测指标。 IMRT之前的PSA（<1.0对1.0 ng / ml）显示出预测bNED的趋势（p = 0.08）。结论：IMRT至75Gy +/- AD可以以低水平的急性和晚期毒性进行递送。对于没有神经周围浸润和包膜浸润且格里森评分>或= 7（3 + 4）的患者，IMRT可提供非常好的5年bNED。

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