Wong Gordon W, Palazzi-Churas Kerrin L, Jarrard David F, Paolone David R, Graf Andrew K, Hedican Sean P, Wegenke John D, Ritter Mark A
Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):449-55. doi: 10.1016/j.ijrobp.2007.06.042. Epub 2007 Sep 14.
To evaluate whether hypofractionation is well tolerated and to preliminarily assess biochemical control of this regimen in a postprostatectomy, salvage setting.
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).
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%.
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.
评估大分割放疗在前列腺切除术后挽救性治疗中的耐受性，并初步评估该方案的生化控制情况。
对2003年5月至2005年12月间接受大分割放疗治疗根治性前列腺切除术后生化复发的50例患者进行回顾性分析。采用调强放疗和每日图像定位技术，对前列腺窝进行放疗，剂量为65 - 70 Gy，分26 - 28次，每次2.5 Gy。使用改良的放射肿瘤学组量表和福克斯蔡斯晚期效应正常组织量表对毒性进行评分。中位随访时间为18.9个月（范围5.3 - 35.9个月）。
未观察到3级或更高级别的急性或晚期毒性反应。2级毒性反应包括4例急性泌尿生殖系统毒性、1例急性胃肠道毒性、2例晚期泌尿生殖系统毒性和2例晚期胃肠道毒性。50例患者中，39例在挽救性治疗后出现持续生化反应，3例在前列腺特异性抗原失败前出现初始反应，7例出现前列腺特异性抗原进展，其中1例死于进行性转移性疾病。最后，1例患者因诊断为异时性胰腺癌而停止治疗，未进行额外的前列腺癌随访即死亡。所有其余患者在最后一次随访时均存活。挽救前较低的前列腺特异性抗原水平是改善生化控制的唯一显著预后因素。2年时估计的精算生化控制率为72.9%。
毒性和早期生化反应率与传统分割放疗的预期一致。需要进一步随访以更好地记录生化控制情况，但这些结果表明大分割放疗是一种耐受性良好的挽救性放疗方法。
