Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy.
Urol Oncol. 2013 Jan;31(1):87-92. doi: 10.1016/j.urolonc.2010.10.005. Epub 2011 Apr 1.
To determine the recommended phase II dose of postoperative accelerated intensity modulated radiotherapy (IMRT) for prostate cancer.
Step and shoot IMRT with simultaneous integrated boost (SIB) was delivered in 25 fractions over 5 weeks to patients with high risk resected prostate adenocarcinoma (stage pT3-4 and/or positive surgical margins). Pelvic nodes received 45 Gy at 1.8 Gy/fraction; dose escalation was performed only to the prostate bed (planned dose escalation: 56.8 Gy at 2.27 Gy/fraction, 59.7 Gy at 2.39 Gy/fraction, 61.25 Gy at 2.45 Gy/fraction, 62.5 Gy at 2.5 Gy/fraction). Dose-limiting toxicity (DLT) was any grade ≥ 3 acute toxicity (RTOG score).
Twenty-five patients were treated: 7 patients at the 56.75 Gy dose level, 6 patients at each subsequent dose level. Pathologic stages were: pT2c: 2; pT3a: 11; pT3b: 12; pN0: 22; pN1: 3; R0: 7; R1: 18. Median follow-up time was 19 months (range: 6-36 months). No patient experienced DLT. Grade 1-2 acute rectal and urologic toxicity was common (17 and 22 patients, respectively).
The recommended dose was 62.5 Gy in 2.5 Gy/fraction. Postoperative hypofractionated IMRT SIB for prostate cancer seemed to be well tolerated and could be tested in phase II studies.
确定前列腺癌术后加速调强放疗（IMRT）的推荐 II 期剂量。
对高风险前列腺腺癌（pT3-4 期和/或阳性手术切缘）患者行 SIB 推量调强放疗，共 25 次，5 周完成。盆腔淋巴结给予 45 Gy，1.8 Gy/次；仅对前列腺床进行剂量递增，计划剂量递增：2.27 Gy/次时 56.8 Gy，2.39 Gy/次时 59.7 Gy，2.45 Gy/次时 61.25 Gy，2.5 Gy/次时 62.5 Gy。任何 2 级以上急性毒性（RTOG 评分）为剂量限制毒性（DLT）。
25 例患者接受治疗：7 例在 56.75 Gy 剂量水平，6 例在随后每个剂量水平。病理分期：pT2c：2；pT3a：11；pT3b：12；pN0：22；pN1：3；R0：7；R1：18。中位随访时间为 19 个月（6-36 个月）。无患者发生 DLT。1 级和 2 级急性直肠和泌尿系统毒性常见（分别为 17 例和 22 例）。
推荐剂量为 2.5 Gy/次时 62.5 Gy。前列腺癌术后短程大分割 IMRT SIB 似乎具有良好的耐受性，可在 II 期研究中进行检验。
