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在最终局部治疗后生化复发的救援疗法:系统性审查,元分析和网络元分析

Akihiro Matsukawa^1,2, Takafumi Yanagisawa^1,2, Tamas Fazekas^1,3,4

¹Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.

Prostate cancer and prostatic diseases

|September 12, 2024

概括

拯救性放射治疗 (RT) 与激素疗法相结合,改善了前列腺癌 (PCa) 患有生化复发 (BCR) 患者的无转移生存率. 对于晚期的BCR,建议使用基剥夺疗法 (ADT) 加上基受体信号抑制剂 (ARSI).

科学领域:

在瘤学瘤学.
泌尿器科泌尿器科泌尿器科泌尿器科
辐射瘤学辐射瘤学

背景情况:

前列腺癌 (PCa) 管理的最新进展包括新型雄激素受体信号抑制剂 (ARSI).
在确定的局部治疗后,生化复发 (BCR) 带来了治疗挑战.
优化BCR的救援疗法对于改善患者的治疗结果至关重要.

研究的目的:

为了比较各种救援疗法的疗效,前列腺癌 (PCa) 患者经历生化复发 (BCR).
为了评估治疗后的激进前列腺切除术 (RP) 或放射治疗 (RT) 对于非转移性PCa的治疗意图.

主要方法:

在2023年10月进行了PubMed,Scopus和Web of Science的系统文献搜索.
包括随机对照试验 (RCT) 和前性研究,报告PCa BCR的救援疗法.
主要终点是无转移性生存 (MFS);次要终点包括无进展性生存 (PFS) 和整体生存 (OS).

主要成果:

包括19项研究 (n=9117),分析基于RT,基于激素和其他救援策略.
与单独治疗RT相比,添加激素治疗来挽救RT显著改善了MFS (HR:0.69).
在基于RT的策略中,选择性节点RT与雄激素剥夺疗法 (ADT) 是最有效的;在MFS和OS的基于激素的策略中,恩扎胺+ADT显示出最大的益处.

结论:

对于BCR后的前列腺切除术,前列腺床RT,选择性骨盆辐射和ADT的组合是首选的救援治疗.
对于其他患者或RT后复发,特别是高风险BCR患者,请考虑将ADT与ARSI结合起来.

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