是否有PSA >或= 20 ng/ml的患者在适形放射治疗后表现良好?

O Algan, W H Pinover, A L Hanlon, T I Al-Saleem, G E Hanks
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引用次数: 13

摘要

确定是否有一个亚组患者,预处理PSA >或= 20 ng/ml,在外部束放射治疗后预后良好。回顾性分析我科2/88 ~ 8/94收治的预处理PSA >或= 20 ng/ml患者129例的治疗结果。患者年龄中位数为70岁(51-89岁)。肿瘤分期T1/T2ab 68例,T2c/T3 61例。初始Gleason分级< 7的有82例,>或= 7的有47例。中位PSA为35 ng/ml(平均45 ng/ml,范围20-191 ng/ml)。97例患者接受四场适形外束放射治疗。治疗前没有患者接受手术或激素治疗。中位中轴剂量为73 Gy (68 ~ 79 Gy)。单因素和多因素分析中考虑的协变量包括中轴剂量、预处理PSA、有无神经周围侵犯、Gleason评分、可触及肿瘤分期和患者年龄。bNED失败定义为PSA >或= 1.5,且连续两次检测均上升。中位随访为50个月(范围3-100个月)。5年时,整个患者的bNED控制率为22%。分析的协变量中,剂量(P < 0.01)、分期(P < 0.01)、Gleason评分(P < 0.01)、PNI是否存在(P = 0.01)在多变量分析中具有显著性。根据这些结果,可以将患者分为两组。第一组19例患者具有T1/T2ab疾病、Gleason评分2-6、未侵犯神经周围,中轴接受剂量> 73 Gy的治疗。II组患者至少具有上述不良预后特征之一,或接受中轴剂量< 73 Gy的治疗。ⅰ组患者的bNED控制率明显高于ⅱ组(58% vs. 23%, P = 0.0027)。在PSA >或= 20 ng/ml的患者中似乎有一个有利的亚组,其中治疗剂量超过73 Gy到中轴是有必要的(四年bNED率为58%)。然而,由于患者人数较少,这些结果将需要更长时间的随访来验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is there a subset of patients with PSA > or = 20 ng/ml who do well after conformal beam radiotherapy?

To determine if there is a subgroup of patients with pretreatment PSA > or = 20 ng/ml with a favorable outcome after external beam radiation therapy. We analyzed retrospectively treatment outcomes of 129 patients with pretreatment PSA > or = 20 ng/ml treated in our department from 2/88-8/94. Median patient age was 70 years (range 51-89 years). Tumor stage was T1/T2ab in 68, T2c/T3 in 61 patients. Initial Gleason grade was < 7 in 82 and > or = 7 in 47 patients. Median PSA was 35 ng/ml (mean 45 ng/ml, range 20-191 ng/ml). Ninety-seven patients received four-field conformal external beam radiation therapy. No patient received surgery or hormonal therapy prior to treatment. Median central axis dose was 73 Gy (range 68-79 Gy). Covariates considered in univariate and multivariate analyses included central axis dose, pretreatment PSA, presence of perineural invasion, Gleason score, palpable tumor stage and patient age. bNED failure was defined as a PSA > or = 1.5 and rising on two consecutive determinations. Median follow up was 50 months (range 3-100 months). Overall bNED control for the entire patient population was 22% at five years. Of the covariates analyzed, dose (P < 0.01), stage (P < 0.01), Gleason Score (P < 0.01), and the presence of PNI (P = 0.01) were significant on multivariate analysis. Based on these results, patients could be stratified into two distinct groups. Group I consisted of 19 patients with favorable features including T1/T2ab disease, Gleason Score 2-6, no perineural invasion treated to a dose > 73 Gy to the central axis. Patients in Group II had at least one of the above poor prognostic features or were treated to central axis doses < 73 Gy. The bNED control was significantly higher for patients in Group I than those in Group II (58% vs. 23%, P = 0.0027). There appears to be a favorable subgroup of patients with PSA > or = 20 ng/ml where treating to doses over 73 Gy to the central axis is warranted (four-year bNED rate of 58%). However, because of the small patient numbers, these results will need to be validated with longer follow up.

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