Background

Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT).

Objective

To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM).

Design, setting, and participants

A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo.

Interventions

WPRT and/or ADT in addition to PBRT.

Outcome measurements and statistical analyses

FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression.

Results and limitation

Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p < 0.001) and no ADT versus ADT (HR 1.70, p < 0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p < 0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p = 0.012). No significant differences in DM cumulative incidence were found.

Conclusions

For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival.

Patient summary

We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning).

中文翻译：

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前列腺癌切除术后挽救性放疗对结节性放射线照射和/或雄激素剥夺疗法的多机构评估

背景

前列腺切除术后抢救性放射治疗（SRT）的结果并不理想。几乎没有证据表明单独或与雄激素剥夺疗法（ADT）联合使用全盆腔放疗（WPRT）的潜在益处。

客观的

探讨是否将WPRT和/或ADT添加到前列腺床放射治疗（PBRT）中可以提高免受生化衰竭（FFBF）或远处转移（DM）的自由度。

设计，设置和参与者

从前列腺切除术后前列腺特异性抗原（PSA）> 0.01 ng / ml的患者的10个学术机构收集数据库；pT1-4，Nx / 0，cM0；在1987年至2013年期间接受了Gleason评分（GS）≥7的治疗。中位随访时间为51 mo。

干预措施

除PBRT外，还包括WPRT和/或ADT。

成果测量和统计分析

FFBF和DM是使用累积发生率估算来计算的。多变量分析（MVA）利用累积发生率回归。

结果与局限性

1861名患者的SRT前PSA的中位数为0.5 ng / ml。未经历生化衰竭（BF）的患者的中位随访时间为55 mo。MVA显示PBRT与WPRT的BF增加（危险比[HR] 1.82，p  <0.001），而ADT与ADT无相关（HR 1.70，p  <0.001）。WPRT与5年期FFBF的相关性为62％，而PBRT为49％（p  <0.001）。使用ADT可以改善5年期FFBF（55％vs 50％，p  = 0.012）。DM累积发生率未发现显着差异。

结论

对于接受SRT的GS≥7的患者，临床医生应权衡WPRT和ADT对FFBF的益处与毒性。未来的研究应探讨WPRT对生活质量，临床进展和总体生存的影响。

病人总结

我们评估了手术切除前列腺后接受放射治疗的前列腺癌患者。辐射到盆腔淋巴结和抑制睾丸激素都降低了增加前列腺特异性抗原（癌症复发的标志物）的机会。