Research progress in adjuvant radiotherapy in the postoperative management of high-risk prostate cancer
10.3760/cma.j.cn113030-20240411-00137
- VernacularTitle:高危前列腺癌术后辅助放射治疗的研究进展
- Author:
Yuanlin LI
1
;
Minghuan LI
Author Information
1. 山东第二医科大学临床医学院，潍坊 261053
- Keywords:
Prostatic neoplasms;
Surgical procedures, operative;
Radiotherapy;
Neoplasm recurrence;
Quality of life
- From:
Chinese Journal of Radiation Oncology
2024;33(12):1158-1163
- CountryChina
- Language:Chinese
-
Abstract:
Approximately 30%-40% of prostate cancer patients undergoing surgical treatment will experience biochemical recurrence. However, this proportion will be increased to 50%-70% among those with locally advanced, high-risk disease. In contrast to the approach of active surveillance, adjuvant radiotherapy (ART) administered after prostate surgery has demonstrated a substantial reduction of approximately 50% in the risk of biochemical recurrence among high-risk patients exhibiting adverse pathological characteristics such as extraprostatic extension, seminal vesicle invasion, a high Gleason score, or positive surgical margins. This conclusion is firmly supported by the results of three prior randomized controlled trials. In three recently published comparative studies, salvage radiation therapy (SRT) and ART were rigorously compared among patients with high-risk prostate cancer who had undergone surgical treatment. The results revealed that the early SRT cohort exhibited comparable rates of event-free survival, clinical outcomes, and radiological progression to those observed in the ART group. Notably, the SRT group reported significantly fewer adverse effects related to urinary and bowel functions, suggesting a more favorable safety profile compared to the ART group. However, there is substantial heterogeneity among the enrolled patient populations across these studies, exhibiting unfavorable characteristics. In real-world settings, we frequently encounter patients with multiple high-risk characteristics and those who have developed pelvic lymph node metastasis postoperatively. Given this, it is imperative to undertake an individualized analysis of these adverse features, which will enable us to precisely identify patients who are most responsive to postoperative ART while effectively mitigating radiotherapy-related adverse effects. Consequently, an improvement can be obtained in patient survival rates while also ensuring their quality of life.
