RESUMEN
BACKGROUND: Postprostatectomy adjuvant or salvage radiotherapy, when using standard fractionation, requires 6.5 to 8 weeks of treatment. The authors report on the safety and efficacy of an expedited radiotherapy course for salvage prostate radiotherapy. METHODS: A total of 108 consecutive patients were treated with salvage radiation therapy to 65 grays (Gy) in 26 fractions of 2.5 Gy. Median follow-up was 32.4 months. Median presalvage prostate-specific antigen (PSA) was 0.44 (range, 0.05-9.50). Eighteen (17%) patients received androgen deprivation after surgery or concurrently with radiation. RESULTS: The actuarial freedom from biochemical failure for the entire group at 4 years was 67% ± 5.3%. An identical 67% control rate was seen at 5 years for the first 50 enrolled patients, whose median follow-up was longer at 43 months. One acute grade 3 genitourinary toxicity occurred, with no acute grade 3 gastrointestinal and no late grade 3 toxicities observed. On univariate analysis, higher Gleason score (P = .006), PSA doubling time ≤12 months (P = .03), perineural invasion (P = .06), and negative margins (P = .06) showed association with unsuccessful salvage. On multivariate analysis, higher Gleason score (P = .057) and negative margins (P = .088) retained an association with biochemical failure. CONCLUSIONS: Hypofractionated radiotherapy (65 Gy in 2.5 Gy fractions in about 5 weeks) reduces the length of treatment by from 1-½ to 3 weeks relative to other treatment schedules commonly used, produces low rates of toxicity, and demonstrates encouraging efficacy at 4 to 5 years. Hypofractionation may provide a convenient, resource-efficient, and well-tolerated salvage approach for the estimated 20,000 to 35,000 US men per year experiencing biochemical recurrence after prostatectomy.
Asunto(s)
Fraccionamiento de la Dosis de Radiación , Recurrencia Local de Neoplasia/radioterapia , Prostatectomía , Neoplasias de la Próstata/radioterapia , Terapia Recuperativa/métodos , Anciano , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Planificación de la Radioterapia Asistida por Computador , Sistema Urogenital/efectos de la radiaciónRESUMEN
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.
Asunto(s)
Fraccionamiento de la Dosis de Radiación , Recurrencia Local de Neoplasia/radioterapia , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/etiología , Radioterapia de Intensidad Modulada , Terapia Recuperativa/métodos , Anciano , Estudios de Seguimiento , Tracto Gastrointestinal/efectos de la radiación , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Antígeno Prostático Específico/sangre , Prostatectomía , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/cirugía , Radioterapia de Intensidad Modulada/efectos adversos , Radioterapia de Intensidad Modulada/métodos , Estudios Retrospectivos , Insuficiencia del Tratamiento , Sistema Urogenital/efectos de la radiaciónRESUMEN
BACKGROUND: The objectives of this study were to determine whether bladder cancer (BC) screening in healthy men could lead to earlier detection and reduced BC mortality compared with unscreened men and to determine long-term outcomes of a geographically defined, unscreened population with newly diagnosed BC. METHODS: In 1987 and from 1998 to 1992, 1575 men ages 50 years and older who were solicited from well patient rosters in clinics in and around Madison, Wisconsin, tested their urine repetitively with a chemical reagent strip for hemoglobin. Participants who had positive test results underwent standard urologic evaluation. BC grades and stages and the outcomes of men with BC detected by screening were compared with the grades, stages, and outcomes of 87% of men ages 50 years and older with newly diagnosed BC who were reported to the Wisconsin Tumor Registry in 1988 (n = 509 men). RESULTS: Two hundred fifty-eight screening participants (16.4%) were evaluated for hematuria, and 21 participants (8.1%) were diagnosed with BC. Proportions of low-grade (Grade 1 and 2) superficial (Stage Ta and T1) versus high-grade (Grade 3) superficial or invasive (Stage > or = T2) cancers in screened men (52.4% vs. 47.7%) and in men from the tumor registry (60.3% vs. 39.7%) were similar (P = .50). The proportion of high-grade superficial or invasive BCs that were invasive were lower in screened men (10%) than in unscreened men (60%; P = .002). At 14 years of follow-up, no men with screen-detected BC had died of BC, whereas 20.4% of men with unscreened BC had died of BC (P = .02). CONCLUSIONS: Screening effected the early detection of BC and may reduce mortality from BC compared with BC that is diagnosed at standard clinical presentation.