Salvage radiotherapy for palpable, locally recurrent prostate cancer after radical prostatectomy

PURPOSE: A retrospective study to evaluate the outcome of salvage radiotherapy (RT) for clinically apparent, palpable prostate cancer recurrence after radical prostatectomy (RP). METHODS AND MATERIALS: Forty-two patients underwent RT for clinically apparent recurrent prostate cancer after RP between 1993 and 1999. The end points and treatment variables of biochemical disease-free survival were evaluated statistically. RESULTS: The median follow-up was 4.3 years. All 42 patients experienced resolution of clinically detectable recurrence within 1 year after RT. The 5-year biochemical disease-free survival, local control, freedom from distant metastases, and overall survival rate was 27%, 94%, 82%, and 78%, respectively. The initial pathologic stage (T3 or T4; p = 0.04) and interval (<2 years from RP to RT; p = 0.01) were independent predictors of biochemical failure, and RT simulation without contrast (p = 0.05) was nearly significant on multivariate analysis. Three patients (7%) experienced chronic Grade 3 or 4 RT-related toxicity. CONCLUSION: Salvage prostate bed RT for clinically apparent locally recurrent prostate cancer after RP provides effective local tumor control with modest durable biochemical control. Patients irradiated with a better simulation technique were found to have a more favorable outcome. A consensus on a definition of biochemical disease-free survival after salvage RT is critical for meaningful comparison of the available data and to future progress in treating this disease process.     

Salvage hypofractionated radiotherapy for biochemically recurrent prostate cancer after radical prostatectomy

PURPOSE: To evaluate whether hypofractionation is well tolerated and to preliminarily assess biochemical control of this regimen in a postprostatectomy, salvage setting. METHODS AND MATERIALS: A retrospective analysis was performed in 50 patients treated between May 2003 and December 2005 with hypofractionated radiotherapy for biochemical recurrence after radical prostatectomy. Radiotherapy was prescribed to the prostatic fossa to 65-70 Gy in 26-28 fractions of 2.5 Gy each, using intensity-modulated radiotherapy with daily image localization. Toxicities were scored using a modified Radiation Therapy Oncology Group scale and the Fox Chase modification of Late Effects Normal Tissue scale. The median follow-up was 18.9 months (range, 5.3-35.9). RESULTS: No Grade 3 or greater acute or late toxicities were observed. Grade 2 toxicities included four acute genitourinary, one acute gastrointestinal, two late genitourinary, and two late gastrointestinal toxicities. Of the 50 patients, 39 demonstrated a continuous biochemical response after salvage therapy, 3 had an initial response before prostate-specific antigen failure, and 7 had prostate-specific antigen progression, 1 of whom died of progressive metastatic disease. Finally, 1 patient discontinued therapy because of the diagnosis of a metachronous pancreatic cancer and died without additional prostate cancer follow-up. All remaining patients were alive at the last follow-up visit. A lower presalvage prostate-specific antigen level was the only significant prognostic factor for improved biochemical control. The estimated actuarial biochemical control rate at 2 years was 72.9%. CONCLUSIONS: The toxicity and early biochemical response rates were consistent with expectations from conventional fractionation. Additional follow-up is required to better document the biochemical control, but these results suggest that hypofractionation is a well-tolerated approach for salvage radiotherapy.     

Adjuvant radiotherapy following radical prostatectomy is more effective and less toxic than salvage radiotherapy for a rising prostate specific antigen

Despite the trend toward earlier diagnosis of adenocarcinoma of the prostate, approximately 25% of men undergoing radical prostatectomy will have pathologic evidence of cancer extending outside of the prostate. These patients are at high risk for subsequent recurrence. Such relapses are almost always manifested initially as a rise in the Prostate Specific Antigen (PSA). Currently utilized PSA assays, however, will not detect a recurrence smaller than 10(7) to 10(8) cells, nor does PSA identify the site of recurrence. In contrast, the pathologic findings at the time of surgery can be used to reliably distinguish patients at risk for local recurrence from those more likely to fail distantly. Furthermore, adjuvant pelvic radiotherapy after prostatectomy, given to patients with an undetectable PSA who are at high risk for local recurrence, results in a higher disease free survival and fewer side effects than if radiotherapy is delayed until the PSA begins to rise. Thus, patients at high risk for local failure following radical prostatectomy, but at low risk for distant metastases (i.e., those with positive surgical margins and an undetectable PSA) should be offered immediate adjuvant radiotherapy.     

Treatment results of adjuvant radiotherapy and salvage radiotherapy after radical prostatectomy for prostate cancer

Background The indications for and the efficacy of radiation therapy after radical operation for patients with prostate cancer are not clear. We analyzed the treatment results of adjuvant radiotherapy and salvage radiotherapy after radical prostatectomy. Methods Between September 1997 and November 2004, 57 patients received adjuvant radiotherapy or salvage radiotherapy after radical prostatectomy. Fifteen patients received radiation therapy because of positive margins and/or extracapsular invasion in surgical specimens (adjuvant group). Forty-two patients received radiation therapy because of rising prostate-specific antigen (PSA) during follow-up (salvage group). Radiation therapy was delivered to the fossa of the prostate ± seminal vesicles by a three-dimensional (3-D) conformal technique to a total dose of 60–66 Gy (median, 60 Gy). Biochemical control was defined as the maintenance of a PSA level of less than 0.2 ng/ml. Results The median follow-up period after radiation therapy was 33 months (range, 12–98 months). Three-year biochemical control rates were 87% for the adjuvant group and 61% for the salvage group. For patients in the salvage group treated without hormone therapy, the preradiation PSA value was the most significant factor for the biochemical control rate. The 3-year biochemical control rate was 93% in patients whose preradiation PSA was 0.5 ng/ml or less and 29% in patients whose preradiation PSA was more than 0.5 ng/ml. No severe adverse effects (equal to or more than grade 3) were seen in treated patients. Conclusion Radiation therapy after radical prostatectomy seemed to be effective for adjuvant therapy and for salvage therapy in patients with a preradiation PSA of 0.5 ng/ml or less. Also, radiation to the fossa of the prostate ± seminal vesicles, to a total dose of 60–66 Gy, using a three-dimensional (3-D) conformal technique, seemed to be safe.     

腮腺癌术后放疗价值探讨

目的 :评价腮腺癌术后放疗的价值。方法 :1984～ 1996年本院收治腮腺癌患者 15 8例 ,行单纯手术 5 8例 ,术后放疗 10 0例。治疗后予以再次手术和 /或放疗的分别为前者 4 3例 ,后者 38例。结果 :单纯手术和术后配合放疗 5年生存率 ,分别为 5 6 90 %和 6 8% (P >0 0 5 ) ,腺癌、腺泡细胞癌和恶性混合瘤等恶性度较高者 ,术后放疗可提高 5年生存率 (P <0 0 5 % )。外侵与面神经受累者 ,术后放疗可减少 3年及 5年的复发率 (P <0 0 1) ,而病灶局限且无面神经受累者及颈部淋巴结转移者 ,术后放疗价值不大。单纯手术后复发 ,再次手术并辅以放疗能提高 3年继续生存率并减少 3年再复发率 (P <0 0 5 ) ;而术后放疗后复发 ,再次放疗价值不大 ,反而导致严重的放疗副反应。结论 :病理恶性度较高以及肿瘤外侵或面神经受累者 ,应予以术后放疗 ;术后放疗后复发 ,再次放疗价值不大 ,反而导致严重的放疗副反应。     

局部晚期直肠癌术前及术后放疗情况分析

目的 探讨2010年卫生部医政司发布《结直肠癌诊疗规范》以来国内地市级医院直肠癌综合治疗的现状。方法 通过门诊、电话、信函等方式随访2010年1月至2013年12月在我院接受根治性手术治疗的直肠癌患者,调查其接受《结直肠癌诊疗规范》制订的新辅助治疗或术后辅助治疗的状况。结果 直肠癌患者共438例,仅有9例患者接受了术前放疗。随访到的有术后放疗指征(T_3-4N₀M₀或TxN_1-2M₀期)患者293例,接受单纯术后放疗18例(6.1%),术后同步放化疗33例(11.3%);242例(82.6%)未接受术后放疗,其中医务人员未履行相应的告知义务为173例,占71.5%。结论 临床医生对综合治疗的理解和认识存在偏差,特别是新辅助治疗的应用还值得探讨和规范。     

48例甲状腺癌术后放疗的临床分析

目的　评价甲状腺癌术后放疗疗效。方法　对 1991年 3月～ 1996年 9月间 ,接受术后放疗的48例甲状腺癌进行总结分析。照射范围 :对分化型者 (乳头状癌、滤泡状癌、髓样癌 )包括瘤床及双颈 ;对未分化型者 (未分化癌 )包括瘤床、双颈及上纵隔 ;采用60 Coγ线加深部 180kvX线或电子流照射 ,照射剂量DT45～ 6 5Gy/ 5 - 7周 ,常规分割照射。结果　全组总的 5年生存率为 81.3% ,其中分化型为 90 .5 % ,未分化型为 16 .7% ,两者比较有显著性差异 (P <0 .0 1)。死亡 9例 ,1例缘于局部复发 ,8例因为远处转移。结论　分化型甲状腺癌首选手术治疗 ,术后T4 N1者需补充放疗 ,未分化型者需采用放化疗综合治疗措施。     

Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy

Background

Spine stereotactic body radiotherapy (SBRT) is increasingly being applied to the postoperative spine metastases patient. Our aim was to identify clinical and dosimetric predictors of local control (LC) and survival.

Methods

Eighty patients treated between October 2008 and February 2012 with postoperative SBRT were identified from our prospective database and retrospectively reviewed.

Results

The median follow-up was 8.3 months. Thirty-five patients (44%) were treated with 18–26 Gy in 1 or 2 fractions, and 45 patients (56%) with 18–40 Gy in 3–5 fractions. Twenty-one local failures (26%) were observed, and the 1-year LC and overall survival (OS) rates were 84% and 64%, respectively. The most common site of failure was within the epidural space (15/21, 71%). Multivariate proportional hazards analysis identified systemic therapy post-SBRT as the only significant predictor of OS (P = .02) and treatment with 18–26 Gy/1 or 2 fractions (P = .02) and a postoperative epidural disease grade of 0 or 1 (0, no epidural disease; 1, epidural disease that compresses dura only, P = .003) as significant predictors of LC. Subset analysis for only those patients (n = 48/80) with high-grade preoperative epidural disease (cord deformed) indicated significantly greater LC rates when surgically downgraded to 0/1 vs 2 (P = .0009).

Conclusions

Postoperative SBRT with high total doses ranging from 18 to 26 Gy delivered in 1–2 fractions predicted superior LC, as did postoperative epidural grade.     

肝癌术后放疗的临床意义（附104例分析）

目的探讨原发性肝癌术后给予辅助放疗的临床意义。方法1999年5月至2007年1月，我院肿瘤科对61例原发性肝癌病人施行手术治疗加术后辅助放疗。放疗方案主要采用先予全肝放疗，靶区包括全肝、第一肝门区、部分腹主动脉、下腔静脉旁淋巴结，DT16～20Gy，1．5～1．8Gy／次。再予瘤床15-20Gy。与同期根治术后未行放射治疗的43例肝癌病人相比较，分析治疗效果及治疗相关并发症。结果术后放疗组1a、3a，5a总生存率为88．5％、70．9％、48．9％；1a、3a、5a局部复发率为18．0％、25．5％、37．8％。术后放疗组1a、3a、5a复发率均较单纯手术组为优，差异有显著的统计学意义；总生存率仅1年生存率术后放疗组优于单纯手术组。未见肝功能进行性恶化、黄疸、腹水等放射性肝炎症状发生。结论放射治疗作为肝癌切除术后的辅助治疗手段，可获得较好疗效。不良反应可耐受。     

非小细胞肺癌术后放疗的研究现状

相当比例的非小细胞肺癌(NSCLC)患者术后需行辅助治疗,术后放疗是其中重要的治疗手段,本文就近年来术后放疗对NSCLC患者的作用和价值作一综述。     

共中线同中心缩野技术放射治疗术后乳腺癌临床观察

目的探讨乳腺癌术后采用共中线同中心缩野技术放疗的疗效和毒副作用。方法回顾性分析本院采用共中线同中心缩野放疗技术治疗的156例乳腺癌术后患者,随访其生存状况及放疗不良反应发生情况。结果 1、3、5年总生存率为100.0%、93.6%、75.6%;1、3、5年无瘤生存率为100.0%、87.2%、71.2%。局部复发率为1.3%（2/156）,未发生有症状的放射性肺炎病例。结论乳腺癌术后采用共中线同中心缩野放射治疗临床疗效可靠,不良反应少,适合乳腺癌的术后放疗。     

术后pN0期食管癌辅助性放疗研究进展

胸腔内—区域复发或和血道转移为食管癌术后患者主要治疗失败模式,作为局部治疗的主要手段之一的放疗在降低食管癌术后患者胸腔内—区域复发的方面具有较好的疗效。目前对于淋巴结阳性患者术后辅助性治疗的价值已得到临床医师的广泛认可,术后辅助性放化疗已然成为了其标准治疗模式。但对于淋巴结阴性的食管癌术后患者是否需要进行辅助性放疗目前并无定论,本文从术后pN₀期食管癌患者需进行辅助性放疗的可能依据、目前的相关报道结果和不同手术方式对其的影响等方面综述了目前对于pN₀期食管癌术后患者是否需要进行辅助性治疗的研究进展。     

胸腺瘤术后辅助放疗的现状及进展

手术切除是胸腺瘤最重要的治疗手段,然而,术后辅助放疗的作用一直存在不同争议。二维放疗时代多数获益不明显,精准放疗技术已使肿瘤放疗发生了较大的变化,胸腺瘤术后放疗价值也可能在改变。目前,放疗在手术切缘阳性或无法行手术切除者的作用是肯定的;在完整手术切除者中,Masaoka-Koga分期Ⅰ期患者无需术后辅助放疗,Ⅱ期患者术后辅助放疗作用争议较大,如果放疗宜考虑Ⅱb期、大体积、B2/B3型等因素;Ⅲ期术后辅助放疗也存在争议,但是多数结果倾向行术后放疗。术后辅助放疗宜采用精准放疗技术,照射范围建议瘤床三维外扩0.5 cm,肿瘤累及的纵隔胸膜及沿纵隔胸膜前后、头脚方向0.5～1.0 cm,肺侧纵隔胸膜为0.5 cm以内,以及肿瘤周血管壁和部分血管间隙,避免包括过多的正常组织。剂量在完全切除时为45~50Gy,非完全切除为54~60Gy或稍高,可能会使放疗获益增加和风险下降。质子、重离子等新型放疗技术的应用可获得剂量学方面的优势,是否能转化为临床获益还需进一步探究。     

腹腔镜前列腺癌根治术经腹腔与经腹膜外途径的效果比较

目的比较腹腔镜下前列腺癌根治术（Laparoscopic radical prostatectom,LRP）经腹腔与经腹膜外途径的临床效果。方法对54例前列腺癌患者行经腹腔镜前列腺癌根治术,其中经腹腔39例,经腹膜外15例。对两组患者术前、术中和术后临床参数和并发症发生率、术后肿瘤学和排尿状况等资料进行统计学分析比较。结果54例手术均获成功,经腹腔与经腹膜外两组手术时间分别为（256±45）min和（263±62）min,P=0．96;出血量分别为（335±296）mL和（352±314）mL,P=0．13;切缘阳性15．4％和13．3％,P=0．61;尿失禁23．1％和20．O％,P=0．61,差异均无统计学意义。两组术后留置导尿时间分别为（14．2±2．7）d和（11．2±3．3）d,P〈0．001;肠功能恢复时间分别为（2．8±0．6）d和（2．0±0．7）d,P=0．04;术后住院时间分别为（17．2±3．5）d和（12．2±3．7）d,P〈0．001,两组比较差异均有统计学意义（P〈0．05）。结论腹腔镜下前列腺癌根治术经腹膜外与经腹腔途径相比具有视野清晰、对腹腔器官影响小、术后恢复快、术后住院时间短等优点,具有临床应用优势。