학술논문
Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer.
Document Type
Academic Journal
Author
Ramey SJ; University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA.; Agrawal S; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Abramowitz MC; University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA. Electronic address: mabramowitz@med.miami.edu.; Moghanaki D; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA; Virginia Commonwealth University Medical Center, Richmond, VA, USA.; Pisansky TM; Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.; Efstathiou JA; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Michalski JM; Washington University School of Medicine, St. Louis, MO, USA.; Spratt DE; University of Michigan, Ann Arbor, MI, USA.; Hearn JWD; University of Michigan, Ann Arbor, MI, USA.; Koontz BF; Duke University Medical Center, Durham, NC, USA.; Liauw SL; University of Chicago, Chicago, IL, USA.; Pollack A; University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA.; Anscher MS; Virginia Commonwealth University Medical Center, Richmond, VA, USA.; Den RB; Sidney Kimmel Medical College at Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA, USA.; Stephans KL; Cleveland Clinic, Cleveland, OH, USA.; Zietman AL; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Lee WR; Duke University Medical Center, Durham, NC, USA.; Stephenson AJ; Cleveland Clinic, Cleveland, OH, USA.; Tendulkar RD; Cleveland Clinic, Cleveland, OH, USA.
Source
Publisher: Elsevier Science Country of Publication: Switzerland NLM ID: 7512719 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-7560 (Electronic) Linking ISSN: 03022838 NLM ISO Abbreviation: Eur Urol Subsets: MEDLINE
Subject
Language
English
Abstract
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).
(Copyright © 2017 European Association of Urology. All rights reserved.)
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).
(Copyright © 2017 European Association of Urology. All rights reserved.)