Risk factors for biochemical recurrence after a tissue-ablative prostate-specific antigen <0.2 ng/mL

PurposeA prostate-specific antigen (PSA) nadir <0.2 ng/mL is generally considered as tissue ablative and at low risk for recurrence. After attaining such a low PSA nadir, we analyzed risk factors for recurrence.Methods and materialsWe identified patients from our institutionalized database with either D'Amico low- or intermediate-risk prostate cancer that was treated with either low-dose-rate prostate brachytherapy or external beam radiotherapy as monotherapy. We compared patients who attained a nadir <0.2 ng/mL and subsequently developed biochemical failure to patients who did not experience biochemical failure by using χ² test and Student t test. Survival analysis was performed using the Kaplan–Meier method (log-rank test).ResultsOf 892 patients, 560 (63%) achieved a nadir <0.2 ng/mL. Only 23 (4.1%) later developed a biochemical recurrence. The 7-year Kaplan–Meier biochemical recurrence-free survival after a PSA nadir of <0.2 ng/mL was 96%. Patients who later experienced biochemical recurrence were more likely to have Cancer of the Prostate Risk Assessment Score intermediate- or high-risk cancer: (74% vs. 40%, p < 0.001). Patients were more likely to have a diagnostic PSA >6.0 ng/mL: (66% vs. 43% p < 0.001) and have a Gleason score ≥ 3  + 4: (52% vs. 34%, p = 0.005). They were also more likely to be older (p = 0.003): mean (SD) 70.3 (6.4) vs. 66.2 (6.5) and have a time to PSA nadir that was significantly shorter (p = 0.013): mean (SD) 51.8 (29.6) vs. 65.2 (25.1).ConclusionsBiochemical recurrence after attaining a PSA nadir <0.2 ng/mL is rare and more frequent in patients with intermediate risk cancer and older patients. These patients can benefit from a prolonged followup with specialized physicians.     

Using a surgical prostate-specific antigen threshold of >0.2 ng/mL to define biochemical failure for intermediate- and high-risk prostate cancer patients treated with definitive radiation therapy in the ASCENDE-RT randomized control trial

PurposeTo compare biochemical failure using a prostate-specific antigen (PSA) threshold of >0.2 ng/mL to that using Phoenix threshold (nadir+2 ng/mL).Methods and MaterialsAndrogen suppression combined with elective nodal and dose-escalated radiation therapy (the ASCENDE-RT trial) is a randomized control trial in which 276 high-risk and 122 intermediate-risk patients were randomized to (1) a standard arm with 12 months of androgen deprivation therapy, pelvic external beam radiation therapy (EBRT) to 46 Gy, and an EBRT boost (dose-escalated EBRT [DE-EBRT]) to 78 Gy, or (2) an experimental arm which substituted a low-dose-rate prostate brachytherapy boost (LDR-PB). The primary endpoint was biochemical progression-free survival (b-PFS) using the Phoenix threshold. In this reanalysis of ASCENDE-RT, the b-PFS using phoenix is compared to the surgical PSA threshold of >0.2 ng/mL.ResultsCompared to nadir+2 ng/mL, the >0.2 ng/mL PSA threshold doubled the number of relapse events from 69 to 139. However, the increase was confined to the DE-EBRT subjects. The 7-year Kaplan-Meier b-PFS after DE-EBRT declined from 76% using nadir+2 ng/mL to 38% using the >0.2 ng/mL threshold (p < 0.001). Among the LDR-PB subset, there was no significant difference in b-PFS; the 7-year Kaplan-Meier b-PFS was 85% (>0.2 ng/mL) versus 88% (nadir+2 ng/mL) (p = 0.319).ConclusionsReplacing Phoenix with a surgical threshold greatly increased biochemical failure after DE-EBRT boost but had no effect after LDR-PB. As a result of this finding, PSA outcomes after surgery or brachytherapy can be directly compared by using the surgical definition of PSA failure. In this context, a brachytherapy boost appears to produce superior b-PFS compared to contemporary surgical series.     

Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT

PurposeWe report on a retrospective comparison of biochemical outcomes using an ultra-high dose of conventionally fractionated intensity-modulated radiation therapy (IMRT) vs. a lower dose of IMRT combined with high-dose-rate (HDR) brachytherapy to increase the biologically effective dose of IMRT.MethodsPatients received IMRT of 86.4 Gy (n = 470) or HDR brachytherapy (21 Gy in three fractions) followed by IMRT of 50.4 Gy (n = 160). Prostate-specific antigen (PSA) relapse was defined as PSA nadir + 2. Median followup was 53 months for IMRT alone and 47 months for HDR.ResultsThe 5-year actuarial PSA relapse-free survival (PRFS) for HDR plus IMRT vs. ultra-high-dose IMRT were 100% vs. 98%, 98% vs. 84%, and 93% vs. 71%, for National Comprehensive Cancer Network low- (p = 0.71), intermediate- (p < 0.001), and high-risk (p = 0.23) groups, respectively. Treatment (p = 0.0006), T stage (p < 0.0001), Gleason score (p < 0.0001), pretreatment PSA (p = 0.0037), risk group (p < 0.0001), and lack of androgen-deprivation therapy (p = 0.0005) were significantly associated with improved PRFS on univariate analysis. HDR plus IMRT vs. ultra-high-dose IMRT (p = 0.0012, hazard ratio [HR] = 0.184); age (p = 0.0222, HR = 0.965); and risk group (p < 0.0001, HR = 2.683) were associated with improved PRFS on multivariate analysis.ConclusionDose escalation of IMRT by adding HDR brachytherapy provided improved PRFS in the treatment of prostate cancer compared with ultra-high-dose IMRT, independent of risk group on multivariate analysis, with the most significant benefit for intermediate-risk patients.     

Prolonged hormonal therapy and external beam radiation independently increase the risk of Persistent Hypogonadism in men treated with prostate brachytherapy

PurposeTo identify variables that predict persistent hypogonadism and castration in patients with prostate cancer (PCa) treated with brachytherapy (BT).Materials and MethodsA retrospective analysis was performed on 1,053 patients receiving BT ± external beam radiation therapy (EBRT) ± hormone therapy (HT) for NCCN low, intermediate, or high-risk PCa between 1990 and 2011. Patients were categorized as not receiving HT (n = 438, 41.6%), ≤6 months (n = 317, 31.1%) or > 6 months (n = 298, 28.3%) of HT. 572 (54.3%) received BT alone, and 481 had combination therapy. The five- and 10-year freedom from persistent hypogonadism (T < 280 ng/dL) and castration (T < 50 ng/dL) for each group was evaluated with Kaplan-Meier estimates. Multivariable cox proportional hazards models were used to compare the risk of persistent hypogonadism and castration at a median followup of 6.5 years (posttreatment to final T) (IQR: 4.3–9.1 years; range: 1.0–19.2 years).ResultsThe 5-year freedom from hypogonadism rates were 92.4%, 88.9%, and 87.0% for patients with no HT, ≤ 6 months and >6 months of HT, respectively (10-year rates: 66.7%, 55.3%, 40.5%); p < 0.01. The 5-year freedom from castration rates were 99.2%, 98.0%, and 98.4%, respectively (10-year rates: 97.9%, 95.5%, 90.9%); p = 0.078. Number of months of HT (HR = 1.04, p = 0.030) and BT with EBRT vs. BT alone (HR = 1.56, p = 0.010) significantly increased the risk of persistent hypogonadism. Number of months of HT was the only variable which increased the risk of persistent castration (HR = 1.09, p = 0.014).ConclusionsThe addition of EBRT to BT is an independent risk factor for persistent hypogonadism. Prolonged HT additionally increases the risk of persistent hypogonadism and castration.     

Utilization of bone scans in conjunction with prostate-specific antigen levels in the surveillance for recurrence of adenocarcinoma after radical prostatectomy.

Follow-up evaluation of patients who have undergone radical prostatectomy routinely consists of serial bone scintigraphy and, more recently, prostate-specific antigen (PSA) levels. The utility of serial bone scans in combination with PSA levels is retrospectively reviewed in 118 men treated by radical prostatectomy for clinical Stage A or B disease who, at the time of surgery, had no evidence of metastatic disease. Of the 118 patients, 75.4% had no abnormality on either test (mean follow-up 32.4 mo), 9.3% demonstrated a detectable or rising PSA level with negative bone scan (mean follow-up 35 mo), and 8.5% exhibited a detectable and or rising PSA level and positive bone scan (mean follow-up 30.7 mo). Follow-up bone scans were read as either positive or indeterminate with undetectable PSA levels in 6.8% of patients (mean follow-up 27.3 mo). Critical review of the equivocal studies suggests that postoperative PSA levels more truly represent the clinical situation than bone scans. Following radical prostatectomy, routine bone scintigraphy provides little additional information when PSA levels are negative. If PSA becomes detectable or the patient develops symptoms, bone scintigraphy should then be performed.     

甲状腺癌术后^131I治疗后唾液腺功能的半定量评价

目的应用放射性核素显像对甲状腺癌术后首次和多次^131I治疗后唾液腺功能的变化进行观察和半定量评价。方法收集56例DTC术后^131I治疗后6个月行唾液腺显像患者,其中21例行首次^131I治疗前及治疗后6个月唾液腺显像。通过计算获得摄取功能参数：4min摄取比值（UR4）和15min摄取比值（UR15）;排泄功能参数：最大排泄量（MS）和酸刺激后腺体计数下降到最低所需的时间（Tmin）。21例首次^131I治疗前后定量参数行配对t检验。将所有唾液腺显像按治疗前、第1次治疗后6个月、第2次治疗后6个月、≥3次治疗后6个月分为4组,各组功能参数进行单因素方差分析和Kruskal-Wallis秩和检验,并对^131I治疗次数与功能参数行Spearman等级相关分析。结果21例首次^131I治疗后6个月,左、右侧腮腺UR15分别下降16％和14％（t值为2．188和3．322,P均〈0．05）,腮腺其余参数及颌下腺所有参数与治疗前比较差异均无统计学意义（t值为-0．952～2．039,P均〉0．05）。按治疗次数分组比较,4组腮腺UR4、UR15、MS如下：左侧分别为1．76±0．29,2．60±0．38,（72．8±24．2）％;1．55±0．34,2．15±0．51,（64．4±21．6）％;1．55±0．40,2．02±0．68,（57．2±34．2）％;1．45±0．33,1．69±0．46,（30．6±36．9）％;右侧分别为：1．81±0．33,2．57±0．51,（69．1±18．5）％;1．61±0．38,2．19±0．59,（64．2±25．0）％;1．60±0．42,2．00±0．62,（53．2±41．7）％;1．48±0．38,1．63±0．29,（26．1±45．9）％;组间差异有统计学意义（左右侧UR4、UR15的F值分别为7．018,13．393和3．112,10．194,左右侧MSH=12．240,26．569,P均〈0．05）。Tmin 4组间差异无统计学意义（左右侧H=2．077,3．019,P均〉0．05）。组间两两比较：^131I治疗1次及2次患者与对照组比较仅UR15减低有统计学意义（P均〈0．05）,但^131I治疗1次与2次组间所有参数差异均无统计学意义（P均〉0．05）,^131I治疗≥3次组双侧腮腺UR4、UR15及MS均显著下降（P均〈0．05）。双侧腮腺UR4、UR15、MS与^131I治疗次数呈负相关,r值为-0．296～-0．566,P均〈0．05。颌下腺各项参数各组间差异均无统计学意义（F值为0．275—1．159,P均〉0．05）。结论DTC术后首次大剂量^131I治疗后6个月仅腮腺摄取功能轻度减低,第2次治疗后腮腺功能损害无明显进展,≥3次^131I治疗后腮腺摄取及排泄均明显受损;颌下腺经多次^131I治疗后仍无明显功能受损。     

食管鳞癌根治性术后的复发模式及复发后再治疗的疗效分析

目的 评估食管鳞癌患者根治术后的复发模式并进行复发后生存时间的预后分析,寻找复发后挽救性治疗的最佳方案。方法 回顾性收集河北医科大学第四医院2007年1月至2011年12月共382例食管癌根治术后区域复发接受再治疗的患者。对患者的术后复发模式及复发后生存时间的影响因素进行统计分析。单因素生存分析采用Kaplan-Meier法和Log-rank检验,多因素生存分析采用Cox回归模型。结果 全组患者1、3、5年生存率分别为80.9%、35.6%、20.4%,中位生存期29.2月,中位复发时间15.0月。患者1、3、5年复发后生存率分别为37.7%、14.6%、11.9%,中位复发后生存时间10.2月。全组382例患者共观察到复发部位462个,其中锁骨上淋巴结区转移95个（20.5%）,吻合口复发46个（10.0%）,纵隔淋巴结区转移259个（56.1%）,上腹部淋巴结区转移62个（13.4%）。接受挽救性放疗、化疗、放化疗及支持治疗的患者分别为156例、43例、82例及101例。单因素预后分析显示T分期、N分期、TNM分期、复发区域个数、复发部位及挽救性治疗方式为影响复发后生存时间的相关因素（χ²=5.336、4.292、8.067、7.482、4.093、76.426,P<0.05）。将接受挽救性放疗的患者按中位剂量60 Gy分为<60 Gy组和≥60 Gy组,两组患者的复发后生存时间差异具有统计学意义（χ²=8.320,P<0.05）,且放疗剂量≥60 Gy组患者的复发后生存预后较优。多因素预后分析显示复发区域个数和挽救性治疗方式为复发后生存时间的独立影响因素。结论 纵隔及锁骨上淋巴结转移是食管癌根治术后最常见的区域复发类型,挽救性放疗或放化疗可以更好地改善复发患者的生存预后。     

High-dose-rate brachytherapy with or without intensity modulated radiation therapy as salvage treatment for an isolated,gross local recurrence of prostate cancer post-prostatectomy

PurposeTo evaluate the use of high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) as salvage therapy for patients with an isolated, gross local recurrence of prostate cancer after radical prostatectomy.Methods and MaterialsBetween October 2009 and May 2013, the authors treated six patients with salvage iridium-192 HDR brachytherapy ± IMRT for biopsy-proven, recurrent prostate cancer post-prostatectomy. In each patient, a pelvic MRI scan or CT scan demonstrated a nodule (range 1.6, 4.7 cm) in the prostate bed. Although prostate-specific antigen values were 0.2–9.5 ng/mL at the time of salvage brachytherapy, there was no pelvic adenopathy on CT or MRI scan, and a bone scan was negative in all cases. Five patients were treated with IMRT to 4500–5040 cGy in 25–28 fractions to the prostate bed followed by two 950 cGy HDR brachytherapy fractions separated by 1–2 weeks. A sixth patient underwent HDR brachytherapy monotherapy consisting of 3800 cGy in four fractions over 3 days. Toxicities were graded according to the Common Terminology Criteria for Adverse Events, version 4.0.ResultsMedian followup was 9 months (range 3, 40 months). All six patients have been free of androgen deprivation therapy and have an undetectable prostate-specific antigen. One patient developed late Grade 2 urinary incontinence. There was no late grade ≥2 gastrointestinal toxicity.ConclusionsHDR brachytherapy ± IMRT is a safe and effective salvage therapy option for an isolated, gross local recurrence of prostate cancer after radical prostatectomy and merits further study.     

A comparison of treatments of squamous cell carcinoma of the base of tongue: surgical resection combined with external radiation therapy, external radiation therapy alone, and external radiation therapy combined with interstitial radiation

PURPOSE: The outcomes of patients treated at a single institution over a specific time frame using three different therapeutic approaches for cancer of the base of tongue were reviewed. METHODS AND MATERIALS: Between 1992 and 1998, 53 patients were treated with curative intent for base of tongue cancer. Seventeen patients underwent surgical resection with postoperative radiation therapy, 16 patients received definitive external radiation therapy only, and 20 patients were treated with external and interstitial radiation, with neck dissection in 16 of those patients. Local control, survival, and functional status were assessed with each approach. RESULTS: The 5-year actuarial local control and survival for the surgically treated patients were 74% and 44%, respectively. The patients treated with external radiation therapy alone had local control of 28% and 5-year survival of 24%. The patients treated with external and interstitial radiation with neck dissection as indicated had 5-year actuarial local control of 87% and survival of 33%. Survival was not statistically different between the three treatment approaches (p=0.0995) but local control was worse in the definitive external radiation group (p < 0.0001). Speech and swallowing function among the long-term survivors was superior in the definitively irradiated patients compared with the operated patients. CONCLUSION: In this retrospective analysis, survival and local control was lowest in the patients treated with external radiation alone, however, patient selection likely played an important role. Local control was far better with surgical treatment and with external combined with interstitial radiation but survival remains less than 50% with each approach. Surgical treatment was superior for patients with T4 disease. Functional status was higher in the long-term survivors treated nonsurgically.     

泽桂癃爽胶囊联合抗雄激素治疗前列腺癌疗效观察

目的 观察泽桂癃爽胶囊联合抗雄激素治疗前列腺癌的效果.方法 选取我院2010年1月～2012年3月雄激素依赖性前列腺癌,且因各种因素无法实施前列腺癌根治手术而接受抗雄激素治疗患者共计36例,采用随机双盲方法分为实验组和对照组各18例.对照组治疗方案：氟他胺250 mg,口服,3次/d;达菲林,肌注3.75 mg,1次/28 d;实验组治疗方案：在对照组治疗方案的基础上,加服泽桂癃爽胶囊2粒,3次/d.治疗持续12个月,从治疗1个月后开始统计,连续12个月每月均对两组患者复查PSA,行IPSS评分.结果 将12个月PSA及IPSS评分作均数分析,实验组PSA0.01 ～ 1.05,平均0.26;IPSS 8 ～ 26,平均11.4.对照组PSA 0.21 ～1.1,平均0.53;IPSS 16～ 28,平均22.3.实验组平均PSA及IPSS均低于对照组,差异有统计学意义（P＜0.05）.结论 泽桂癃爽胶囊配合抗雄激素治疗前列腺癌,可有效降低患者PSA、IPSS,控制前列腺癌患者疾病进展和改善尿路梗阻症状.     

Cost-effectiveness of prostate boost with high-dose-rate brachytherapy versus intensity-modulated radiation therapy in the treatment of intermediate-high risk prostate cancer

PurposeThe recently published ASCENDE-RT randomized clinical trial demonstrated improved biochemical control, albeit with increased toxicity, for a prostate boost with brachytherapy versus external beam radiation therapy alone in patients with intermediate-high risk prostate cancer. In this study, we investigated the cost-effectiveness of these two modalities in the treatment of intermediate-high risk prostate cancer.Methods and materialsA multistate Markov model was created to model a patient with intermediate-high risk prostate cancer. The two treatment options modeled were (1) 23 fractions of intensity-modulated radiation therapy (IMRT) and two fractions of high-dose-rate prostate brachytherapy (brachytherapy boost) and (2) 44 fractions of IMRT (IMRT alone). Each patient received 1 year of hormone therapy, per the ASCENDE-RT protocol. Model assumptions, including clinical outcomes, toxicity, and utilities were derived from the medical literature. Costs of radiation therapy were estimated using Medicare reimbursement data.ResultsThe estimated expected lifetime cost of brachytherapy boost was $68,696, compared to $114,944 for IMRT alone. Brachytherapy boost significantly lowered expected lifetime treatment costs because it decreased the incidence of metastatic castration-resistant prostate cancer, cutting the use of expensive targeted therapy for metastatic castration-resistant prostate cancer. Brachytherapy boost had an expected quality-adjusted life years of 10.8 years, compared to 9.3 years for IMRT alone. One-way sensitivity analyses of our results found brachytherapy boost to be cost-effective over a wide range of cost, utility, and cancer progression rate assumptions.ConclusionsIMRT with high-dose-rate brachytherapy boost is a cost-effective treatment for intermediate-high risk prostate cancer compared to IMRT alone.     

Management of ductal carcinoma in situ with accelerated partial breast irradiation brachytherapy: Implications for guideline expansion

PurposeAccelerated partial breast irradiation (APBI) for patients with ductal carcinoma in situ (DCIS) is controversial, and the suitability criteria from the American Brachytherapy Society (ABS), American Society of Therapeutic Radiology and Oncology (ASTRO), and the European Society for Radiotherapy and Oncology (GEC-ESTRO) have important differences.Methods and MaterialsThis is a single-institution retrospective review of 169 consecutive patients with DCIS who underwent lumpectomy followed by APBI intracavitary brachytherapy from 2003 to 2018. Outcomes, including overall survival, recurrence-free survival (RFS), ipsilateral breast tumor recurrence, and distant metastasis, were estimated with the Kaplan–Meier method.ResultsThe median followup time was 62.5 months. Median age was 66 years (47–89 years). The majority of patients had estrogen receptor–positive disease (89%). Fifty patients (30%) had Grade 3 disease. Of the 142 patients with adequate pathology interpretation, 91 and 108 cases had margins ≥ 3 mm and ≥2 mm, respectively. Most patients (72%) were prescribed and started endocrine therapy. Of the patients evaluable for ABS criteria (N = 130), 97 met the suitability criteria. Of the patients evaluable for ASTRO criteria (N = 129), 42 were deemed cautionary and 33 were deemed unsuitable. Of the patients evaluable for GEC-ESTRO criteria (N = 143), 141 cases were at intermediate risk and two were at high risk. Five-year ipsilateral breast tumor recurrence, RFS, and overall survival were 0.6%, 97.7%, and 97.2%, respectively. The ABS, ASTRO, and GEC-ESTRO criteria failed to significantly predict for RFS.ConclusionsThese results, although limited by short-term followup, indicate that expansion of the eligibility criteria of APBI for patients with DCIS should be considered.     

Sr-89 therapy: Strontium kinetics in disseminated carcinoma of the prostate

Strontium kinetics were investigated in a group of 14 patients receiving ⁸⁹Sr palliation for metastatic bone disease secondary to prostatic carcinoma. Using ⁸⁵Sr as a tracer, total body strontium retention R(t) was monitored for a 3 month period following ⁸⁹Sr administration, and at 90 days was found to vary from 11% to 88% and to correlate closely with the fraction of the skeleton showing scintigraphic evidence of osteoblastic metastatic involvement. Strontium renal plasma clearance varied from 1.6 l/day to 11.6 l/day, and in nine patients was significantly reduced compared with values found in healthy adult men, probably due to increased renal tubular reabsorption associated with the disturbance of calcium homoeostasis. Renal clearance rate was the principal factor determining R(t) for t<6 days, and was an important secondary factor at later times. Over the interval 30 days t<90 days, R(t) was closely fitted by the power law function R(t)=R ₃₀ (t/30)^-b, with R ₃₀ and b showing the close correlation expected from the effect of R(t) on strontium recycling. The correction of the data for this effect to determine the true skeletal release rate is described. Measurement of localized strontium turnover in individual metastatic deposits from whole body profiles and scintigraphic images gave retention curves that typically rose to a plateau by 10 days after therapy, and then decreased very slowly. In contrast, retention curves for adjacent normal trabecular bone showed more rapid turnover, peaking at 1 day and subsequently decreasing following a t^-0.2 power law function. The changes in strontium kinetics found in metastatic bone disease are favourable to the objectives of ⁸⁹Sr therapy.     

放射性125I粒子组织间植入治疗不能手术唾液腺癌患者的生存质量分析

目的 初步评价放射性¹²⁵I粒子组织间植入近距离治疗不能手术唾液腺癌患者的生存质量（quality of life,QOL）及影响因素。方法 选择2013年至2017年间就诊于北京大学口腔医院颌面外科的不能手术唾液腺癌患者23例,行单纯¹²⁵I放射性粒子组织间植入近距离治疗,应用QLQ-C30（V3.0）及QLQ-H&N35中文版生存质量量表,评价患者的生存质量情况,并分析疾病及治疗相关因素对生存质量的影响。结果 23例患者治疗后1年及3年总生存率分别为100%与67%,其治疗前及治疗后生存质量评分平均分为201.48分和199.48分,差异无统计学意义（P>0.05）,患者总体生存质量评分及各项功能评分均处于较高水平。疾病及治疗相关因素中,肿瘤发生部位对患者生存质量的影响具有统计学意义（F=9.127,P<0.05）,其余因素的影响规律尚需更大样本量的研究。结论 ¹²⁵I放射性粒子组织间植入近距离治疗能较好的保存不能手术唾液腺癌患者的头颈部功能和生存质量。     

The role of radiation therapy in the treatment of Stage II endometrial cancer: A large database study

PurposeThe optimum adjuvant treatment for Stage II endometrial cancer patients is unknown. External beam radiation therapy (EBRT) is often considered the standard of care; however, retrospective series suggest that brachytherapy (BT) alone may be sufficient for selected patients. As randomized data are lacking, we used a large database to explore this question.Methods and MaterialsThe National Cancer Data Base was queried for patients with pathologic International Federation of Gynecology and Obstetrics Stage II disease. Demographic, clinic-pathologic, and treatment details were compared between patients. Multivariable analysis was used to determine factors associated with receiving radiation therapy (RT). To account for imbalances between groups, a matched-pair analysis was completed.ResultsEight thousand one hundred forty patients were included. RT was associated with overall survival (OS), with EBRT (hazard ratio [HR] 0.64), BT (HR 0.47), and combination (HR 0.54) showing increased OS on univariate analysis. Facility, urban location, diagnosis year, hysterectomy type, and chemotherapy did not reach significance. On multivariate analysis, RT was associated with OS, with EBRT (HR 0.69), BT (HR 0.60), and combination (HR 0.54) showing benefit. Using propensity-score matching, RT continued to show improved OS regardless of type: BT (82% vs. 73% 5-year OS) and EBRT (77% vs. 71%). BT as compared to EBRT had equivalent survival (81% vs. 79%, not statistically significant).ConclusionThis study of over 8,000 patients demonstrates that adjuvant RT confers a survival benefit in Stage II endometrial cancer and supports the continued use of RT in these patients. BT alone may be reasonable in carefully selected patients.     

核素125I标记hTERT/PSA启动子双调控溶瘤腺病毒对前列腺癌靶向治疗及肿瘤微环境的影响

目的 探究¹²⁵I-RSOAds-hTERT/PSA溶瘤腺病毒对前列腺癌靶向治疗作用以及对肿瘤微环境的影响。方法 采用PCR扩增技术及双酶切连接技术构建¹²⁵I-RSOAds-hTERT/PSA溶瘤腺病毒（¹²⁵I-病毒复合物）。通过缺口末端标记法（TUNEL）染色,流式细胞实验以及Caspase-3的免疫印迹实验分别从体内和体外检测¹²⁵I-病毒复合物对前列腺癌细胞的杀伤作用。通过酶联免疫吸附实验（ELISA）法检测人前列腺癌细胞株PC3和小鼠前列腺癌细胞株RM-1培养上清液及血清中的白介素2（IL-2）、IL-10、肿瘤坏死因子α（TNF-α）、γ干扰素（IFN-γ）等的分泌水平,探究¹²⁵I-病毒复合物对瘤组织细胞因子分泌水平的影响。通过免疫组织化学法以及免疫荧光实验探究¹²⁵I-病毒复合物对前列腺癌组织及癌细胞中CD24、CD44以及前列腺干细胞抗原（PSCA）表达的调节,同时检测瘤组织中CD32和血管内皮生长因子（VEGF）表达水平,以及CD4+、CD8+和巨噬细胞浸润情况。结果 ¹²⁵I-病毒复合物体内、体外均可显著诱导癌细胞凋亡,同时显著高于¹²⁵I组和病毒复合物组。同时IL-2（t=-183.30、-38.20,P<0.05）、IL-10（t=113.80、92.71,P<0.05）、TNF-α（t=-73.20、-73.91,P<0.05）、IFN-γ（t=-65.37、-139.70,P<0.05）在体内体外含量均升高。¹²⁵I-病毒复合物可降低癌细胞及癌组织中CD24、CD44以及PSCA表达,减小癌组织重量（t=8.55,P<0.05）,抑制癌组织血管生成,同时调节肿瘤组织中免疫反应。结论 ¹²⁵I-病毒复合物溶瘤腺病毒对前列腺癌靶向可显著杀伤癌细胞,减少癌组织重量和血管生成,同时改善肿瘤微环境。     

Mammographic features of local recurrence after conservative surgery and radiation therapy: comparison with that of the primary tumor

Purpose: To compare the mammographic features of recurrent breast cancer with those of the primary tumor and to determine whether certain mammographic features are associated with a higher risk of local recurrence after breast-conserving therapy.

Material and Methods: A retrospective review of mammograms of 421 patients who were treated with conservative surgery and radiotherapy revealed 41 recurrent tumors. Mammographic findings, location, and histopathologic characteristics were retrospectively compared between primary and recurrent tumors.

Results: Recurrent tumors were similar in mammographic appearance to primary tumors in 27 (66%) cases. Of 27 primary tumors that occurred as masses without calcifications, 19 (70%) recurred as a mass, and of the six isolated calcifications, five (83%) recurred with calcifications. Ten (53%) of the 19 recurrent masses and five (100%) of the five recurrent calcifications had morphologic features that were similar to those of the primary tumor. Ninety-two percent (11/12) of the recurrences containing microcalcifications (isolated or associated with a mass) had microcalcifications in their primary tumor. Of 27 masses that recurred, the morphology of the primary tumor was obscured in 13 (48%), ill defined in 10 (37%), and spiculated in four (15%) of the masses. Seventy-six percent (31/41) of recurrences were within the lumpectomy quadrant. In 25 (61%) cases, the histologic findings from the primary tumor and the recurrence were identical.

Conclusion: The majority of recurrent tumors appear to be mammographically similar to primary tumors. Therefore, it is important to review preoperative mammograms during follow-up of these patients. Although the study population is small, it was noted that mass with spiculated contour is associated with a lower risk for local recurrence.     

Variations in patterns of concurrent androgen deprivation therapy use based on dose escalation with external beam radiotherapy vs. brachytherapy boost for prostate cancer

PurposeRetrospective data suggest less benefit from androgen deprivation therapy (ADT) in the setting of dose-escalated definitive radiation for prostate cancer, especially when a combination of external beam radiotherapy (EBRT) and brachytherapy approaches are used. This study aimed to test the hypothesis that patients with prostate cancer with intermediate- or high-risk disease undergoing extreme dose escalation with a brachytherapy boost are less likely to receive ADT.Methods and MaterialsData from the National Cancer Database were extracted for men aged 40–90 years diagnosed with node-negative, non-metastatic prostate cancer from 2004 to 2015. Only patients with intermediate- or high-risk disease who were treated with definitive radiotherapy were included. The association and patterns of care between dose escalated radiotherapy and ADT receipt were assessed using multivariable logistic regression.ResultsPatients with unfavorable intermediate- and high-risk prostate cancer were significantly less likely to receive ADT if they underwent dose escalation with a combination of EBRT and brachytherapy (odds ratio 0.67, p < 0.0001). Over time, this decrease in ADT utilization has widened for patients with unfavorable intermediate-risk disease. There was no difference in ADT utilization when comparing patients treated with non–dose-escalated EBRT to those treated with dose-escalated EBRT (without brachytherapy).ConclusionIn this large national database, patients with unfavorable intermediate- and high-risk prostate cancer were significantly less likely to receive guideline-indicated ADT if they underwent extreme dose escalation with combined radiation modalities. As we await prospective data guiding the utility of ADT with dose escalated radiation, these findings suggest potential underutilization of ADT in patients at higher risk of advanced disease.     

Relationship between PSA kinetics and [18F]fluorocholine PET/CT detection rates of recurrence in patients with prostate cancer after total prostatectomy

Purpose

The aim of the present study was to identify prostate-specific antigen (PSA) threshold levels, as well as PSA velocity, progression rate and doubling time in relation to the detectability and localization of recurrent lesions with [¹⁸F]fluorocholine (FC) PET/CT in patients after radical prostatectomy.

Methods

The study group comprised 82 consecutive patients with biochemical relapse after radical prostatectomy. PSA levels measured at the time of imaging were correlated with the FC PET/CT detection rates in the entire group with PSA velocity (in 48 patients), with PSA doubling time (in 47 patients) and with PSA progression (in 29 patients).

Results

FC PET/CT detected recurrent lesions in 51 of the 82 patients (62%). The median PSA value was significantly higher in PET-positive than in PET-negative patients (4.3?ng/ml vs. 1.0?ng/ml; p?p?p?p?=?0.071).

Conclusion

In a study cohort of patients with biochemical recurrence of prostate cancer after radical prostatectomy there emerged clear PSA thresholds for the presence of FC PET/CT-detectable lesions.     

肾部分切除术后尿漏介入栓塞治疗(2例并文献复习)

目的 探讨介入栓塞治疗在肾部分切除术后尿漏的临床应用及疗效.方法 报道2例肾部分切除术后尿漏患者的治疗,手术采用Seldinger方法穿刺右股动脉,将5 F Cobre导管置于患侧肾动脉内,造影确定残余肾动脉分支后,用PVA颗粒及微弹簧圈栓塞病变血管及分支,术后观察患者症状改善情况及相关并发症的发生.结果 2例患者均取得满意疗效,术后第1日引流液即明显减少.1例栓塞术后3d拔除引流管,1例栓塞术后2周拔除引流管.2例术中及围术期均无明显并发症发生.随访至今,无肾积水及肾功能损害发生.结论 超选择性肾动脉栓塞术以其微创、安全、有效、可以最大限度保留肾功能等优点,成为治疗肾部分切除术后尿漏的首选方法.