Irradiation for locally recurrent carcinoma of the prostate following radical prostatectomy.

摘要

OBJECTIVES: To evaluate the outcome of patients treated with irradiation (RT) for isolated, clinically apparent local tumor recurrence following prostatectomy for carcinoma of the prostate (CaP). METHODS: Between May 1979 and July 1992, 35 patients received external-beam RT as sole salvage therapy for post-prostatectomy locally recurrent CaP. Patient outcome was evaluated through retrospective medical record review with respect to clinical and prostate-specific antigen-based (that is, biochemical) control rates, as well as disease-free (clinical and biochemical) and overall survival estimates. Chronic RT-induced morbidity was also examined, and pre-RT disease characteristics were evaluated for their association with disease outcome. RESULTS: With median follow-up of 5.2 years (range 1.7 to 12.1) in survivors (30 patients), 19 patients (54%) had clinical (local, 1 patient [3%]; metastatic, 7 patients [20%]) or biochemical only (11 patients [31%]) relapse. The 8-year clinical relapse-free and any relapse-free (clinical or biochemical) rates were 80% and 56%, respectively, whereas the overall survival estimate was 97%. A chronic complication(s) of treatment was noted in 15 patients (43%) but spontaneously resolved in all but 6 (17%); persistent complications were mild and associated with rectal (grade 1 to 2, 14%) and lymphatic (3%) systems. The interval between prostatectomy and local tumor recurrence, the pre-RT prostate-specific antigen serum level, the pathologic stage, and tumor differentiation may be associated with disease outcome. CONCLUSIONS: External-beam RT resulted in excellent local tumor control without serious long-term morbidity in most patients. Although this study could not define an optimal management strategy (for example, symptomatic measures only, RT, or hormonal therapy), these results provided outcome measures, in relationship to pre-RT tumor-related factors, that may be valuable for clinical decision-making.