Salvage Radiation Therapy Dose Response for Biochemical Failure of Prostate Cancer After Prostatectomy-A Multi-Institutional Observational Study

被引:49
作者
Pisansky, Thomas M. [1 ]
Agrawal, Shree [2 ]
Hamstra, Daniel A. [3 ]
Koontz, Bridget F. [4 ]
Liauw, Stanley L. [5 ]
Efstathiou, Jason A. [6 ]
Michalski, Jeff M. [7 ]
Feng, Felix Y. [3 ]
Abramowitz, Matthew C. [8 ]
Pollack, Alan [8 ]
Anscher, Mitchell S. [9 ]
Moghanaki, Drew [9 ,10 ]
Den, Robert B. [11 ]
Stephans, Kevin L. [12 ]
Zietman, Anthony L. [6 ]
Lee, W. Robert [4 ]
Kattan, Michael W. [13 ]
Stephenson, Andrew J. [14 ]
Tendulkar, Rahul D. [12 ]
机构
[1] Mayo Clin, Dept Radiat Oncol, 200 First St SW, Rochester, MN 55905 USA
[2] Case Western Reserve Univ, Sch Med, Cleveland, OH USA
[3] Univ Michigan, Dept Radiat Oncol, Ann Arbor, MI 48109 USA
[4] Duke Canc Inst, Dept Radiat Oncol, Durham, NC USA
[5] Univ Chicago, Dept Radiat & Cellular Oncol, Chicago, IL 60637 USA
[6] Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA
[7] Washington Univ, Dept Radiat Oncol, St Louis, MO USA
[8] Univ Miami, Dept Radiat Oncol, Miami, FL USA
[9] Virginia Commonwealth Univ, Dept Radiat Oncol, Richmond, VA USA
[10] Hunter Holmes McGuire Vet Adm Med Ctr, Richmond, VA USA
[11] Thomas Jefferson Univ, Dept Radiat Oncol, Philadelphia, PA 19107 USA
[12] Cleveland Clin, Dept Radiat Oncol, Cleveland, OH 44106 USA
[13] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA
[14] Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2016年 / 96卷 / 05期
关键词
INTENSITY-MODULATED RADIOTHERAPY; RADICAL PROSTATECTOMY; TOXICITY; ADJUVANT; SURVIVAL; RELAPSE; MODEL;
D O I
10.1016/j.ijrobp.2016.08.043
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To determine whether a dose-response relationship exists for salvage radiation therapy (RT) of biochemical failure after prostatectomy for prostate cancer. Methods and Materials: Individual data from 1108 patients who underwent salvage RT at 10 academic centers were pooled. The cohort was enriched for selection criteria more likely associated with tumor recurrence in the prostate bed (margin positive and pre-RT prostate-specific antigen [PSA] level of <= 2.0 ng/mL) and without the confounding of planned androgen suppression. The cumulative incidence of biochemical failure and distant metastasis over time was computed, and competing risks hazard regression models were used to investigate the association between potential predictors and these outcomes. The association of radiation dose with outcomes was the primary focus. Results: With a 65.2-month follow-up duration, the 5- and 10-year estimates of freedom from post-RT biochemical failure (PSA level >0.2 ng/mL and rising) was 63.5% and 49.8%, respectively, and the cumulative incidence of distant metastasis was 12.4% by 10 years. A Gleason score of >= 7, higher pre-RT PSA level, extraprostatic tumor extension, and seminal vesicle invasion were associated with worse biochemical failure and distant metastasis outcomes. A salvage radiation dose of >= 66.0 Gy was associated with a reduced cumulative incidence of biochemical failure, but not of distant metastasis. Conclusions: The use of salvage radiation doses of >= 66.0 Gy are supported by evidence presented in the present multicenter pooled analysis of individual patient data. The observational reporting method, limited sample size, few distant metastasis events, modest follow-up duration, and elective use of salvage therapy might have diminished the opportunity to identify an association between the radiation dose and this endpoint. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:1046 / 1053
页数:8
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