Winthrop University Hospital, 264 Old Country Road, Mineola, NY 11501, USA.
BMC Urol. 2010 Feb 1;10:1. doi: 10.1186/1471-2490-10-1.
Improved understanding of prostate cancer radiobiology combined with advances in delivery of radiation to the moving prostate offer the potential to reduce treatment-related morbidity and maintain quality of life (QOL) following prostate cancer treatment. We present preliminary results following stereotactic body radiotherapy (SBRT) treatment for organ-confined prostate cancer.
SBRT was performed on 304 patients with clinically localized prostate cancer: 50 received 5 fractions of 7 Gy (total dose 35 Gy) and 254 received 5 fractions of 7.25 Gy (total dose 36.25 Gy). Acute and late toxicity was assessed using the Radiation Therapy Oncology Group scale. The Expanded Prostate Cancer Index Composite questionnaire was used to assess QOL. Prostate-specific antigen response was monitored.
At a median 30-month (26 - 37 month, range) follow-up there were no biochemical failures for the 35-Gy dose level. Acute Grade II urinary and rectal toxicities occurred in 4% of patients with no higher Grade acute toxicities. One Grade II late urinary toxicity occurred with no other Grade II or higher late toxicities. At a median 17-month (8 - 27 month, range) follow-up the 36.25 Gy dose level had 2 low- and 2 high-risk patients fail biochemically (biopsy showed 2 low- and 1 high-risk patients were disease-free in the gland). Acute Grade II urinary and rectal toxicities occurred in 4.7% (12/253) and 3.6% (9/253) of patients, respectively. For those patients with a minimum of 12 months follow-up, 5.8% (12/206) had late Grade II urinary toxicity and 2.9% (6/206) had late Grade II rectal toxicities. One late Grade III urinary toxicity occurred; no Grade IV toxicities occurred. For both dose levels at 17 months, bowel and urinary QOL returned to baseline values; sexual QOL decreased by 10%.
The low toxicity and maintained QOL are highly encouraging. Additional follow-up is needed to determine long-term biochemical control and maintenance of low toxicity and QOL.
对前列腺癌放射生物学的理解不断提高，再加上对移动前列腺放射治疗技术的进步，使我们有可能降低治疗相关的发病率，并在前列腺癌治疗后保持生活质量（QOL）。我们报告了立体定向体部放疗（SBRT）治疗局限性前列腺癌的初步结果。
对 304 例临床局限性前列腺癌患者进行 SBRT：50 例患者接受 5 次 7 Gy 剂量（总剂量 35 Gy），254 例患者接受 5 次 7.25 Gy 剂量（总剂量 36.25 Gy）。采用放射治疗肿瘤协作组（RTOG）量表评估急性和晚期毒性。采用前列腺癌指数综合问卷（Expanded Prostate Cancer Index Composite questionnaire）评估 QOL。监测前列腺特异性抗原反应。
中位随访时间为 30 个月（26-37 个月，范围），35 Gy 剂量水平无生化失败。4%的患者出现急性 II 级尿和直肠毒性，无更高等级的急性毒性。1 例发生 II 级晚期尿毒性，无其他 II 级或更高等级的晚期毒性。中位随访 17 个月（8-27 个月，范围），36.25 Gy 剂量水平有 2 例低危和 2 例高危患者生化失败（活检显示 2 例低危和 1 例高危患者在腺体中无疾病）。4.7%（12/253）和 3.6%（9/253）的患者分别发生急性 II 级尿和直肠毒性。对于随访至少 12 个月的患者，5.8%（12/206）出现晚期 II 级尿毒性，2.9%（6/206）出现晚期 II 级直肠毒性。1 例发生晚期 III 级尿毒性，无 IV 级毒性。在两个剂量水平的 17 个月时，肠道和尿 QOL 均恢复到基线值；性 QOL 下降了 10%。
低毒性和保持 QOL 非常令人鼓舞。需要进一步随访以确定长期生化控制和维持低毒性和 QOL。
