Adjuvant radiotherapy following radical prostatectomy for prostate cancer

被引:81
作者
Daly, Tiffany [1 ]
Hickey, Brigid E. [1 ]
Lehman, Margot [2 ]
Francis, Daniel P. [3 ]
See, Adrienne M. [4 ]
机构
[1] Princess Alexandra Hosp, Mater Ctr Radiat Oncol Serv, Brisbane, Qld 4101, Australia
[2] Princess Alexandra Hosp, Radiat Oncol Unit, Brisbane, Qld 4102, Australia
[3] Queensland Hlth, Cent Area Hlth Serv, Populat Hlth Serv, Stafford Dc, Australia
[4] Princess Alexandra Hosp, Radiat Oncol Serv, Mater Ctr, Brisbane, Qld 4102, Australia
来源
COCHRANE DATABASE OF SYSTEMATIC REVIEWS | 2011年 / 12期
关键词
QUALITY-OF-LIFE; EXTERNAL-BEAM RADIOTHERAPY; CAUSE URINARY-INCONTINENCE; POSITIVE SURGICAL MARGINS; RADIATION-THERAPY; PHASE-III; POSTOPERATIVE RADIOTHERAPY; ANDROGEN DEPRIVATION; HIGH-RISK; SALVAGE RADIOTHERAPY;
D O I
10.1002/14651858.CD007234.pub2
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Background Men who have a radical prostatectomy (RP) for prostate cancer that does not involve lymph nodes, but extends beyond the prostate capsule into the seminal vesicles or to surgical margins, are at increased risk of relapse. In men with these high risk factors, radiotherapy (RT) directed at the prostate bed after surgery may reduce this risk, and be curative. Objectives To evaluate the effect of adjuvant RT following RP for prostate cancer in men with high risk features compared with RP. Search methods We searched the Cochrane Prostatic Diseases and Urological Cancers Specialised Register (23 February 2011), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE (January 1966 to February 2011), PDQ (R) (Physician Data Query) trial registry databases for ongoing studies (2 November 2010), reference lists from selected studies and reviews, and handsearched relevant conference proceedings. Selection criteria Randomised controlled trials (RCT) comparing RP followed by RT with RP alone. Data collection and analysis Two authors independently assessed the studies for inclusion and bias and extracted data for analysis. Authors were contacted to clarify data and obtain missing information. Main results We found three RCTs involving 1815 men. Adjuvant RT following prostatectomy did not affect overall survival at 5 years (RD (risk difference) 0.00; 95% CI -0.03 to 0.03), but improved survival at 10 years (RD -0.11; 95% CI -0.20 to -0.02). Adjuvant RT did not improve prostate cancer-specific mortality at 5 years (RD -0.01; 95% CI -0.03 to 0.00). Adjuvant RT did not reduce metastatic disease at 5 years (RD -0.00; 95% CI -0.04 to 0.03), but reduced it at 10 years (RD -0.11; 95% CI -0.20 to -0.01). It improved local control at 5 and 10 years (RD -0.10; 95% CI -0.13 to -0.06 and RD -0.14; 95% CI -0.21 to -0.07, respectively), and biochemical progression-free survival at 5 years and 10 years (RD -0.16; 95% CI -0.21 to -0.11 and RD -0.29; 95% CI -0.39 to -0.19, respectively). There were no data for clinical disease-free survival. Adjuvant RT increased acute and late gastrointestinal toxicity [ do you have the rd for this?], urinary stricture (RD 0.05; 95% CI 0.01 to 0.09) and incontinence (RD 0.04; 95% CI 0.01 to 0.08). It did not increase erectile dysfunction or degrade quality of life (RD 0.01; 95% CI -0.06 to -0.26), but with limited data. Authors' conclusions Adjuvant RT after RP improves overall survival and reduces the rate of distant metastases, but these effects are only evident with longer follow up. At 5 and 10 years it improves local control and reduces the risk of biochemical failure, although the latter is not a clinical endpoint. Moderate or severe acute and late toxicity is minimal. There is an increased risk of urinary stricture and incontinence, but no detriment to quality of life, based on limited data. Given that the majority of men who have undergone a RP have a longer life expectancy, radiotherapy should be considered for those with high-risk features following radical prostatectomy. The optimal timing is unclear.
引用
收藏
页数:50
相关论文
共 100 条
[1]
Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: Continued rise of biochemical failure after 5 years [J].
Amling, CL ;
Blute, ML ;
Bergstralh, EJ ;
Seay, TM ;
Slezak, J ;
Zincke, H .
JOURNAL OF UROLOGY, 2000, 164 (01) :101-105
[2]
[Anonymous], ASCO ANN M P J CLIN
[3]
[Anonymous], J UROLOGY
[4]
[Anonymous], 36 ANN JC KIMBR UR S
[5]
[Anonymous], NCT00949962
[6]
[Anonymous], J UROLOGY
[7]
[Anonymous], P AM SOC CLIN ONCOL
[8]
[Anonymous], J CLIN ONCOLOGY 2005
[9]
[Anonymous], NCT00860652
[10]
[Anonymous], INT J RAD ONCOLOGY B