Takaha Natsuki, Okihara Koji, Kamoi Kazumi, Kimura Yasunori, Yamada Takeshi, Kawauchi Akihiro, Kobayashi Kana, Yamazaki Hideya, Nishimura Tsunehiko, Miki Tsuneharu
Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan. ntakaha @ koto.kpu-m.ac.jp
Urol Int. 2011;87(1):28-34. doi: 10.1159/000324478. Epub 2011 Jun 23.
To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) combined with androgen deprivation therapy (ADT) for Japanese high-risk prostate cancer (PCa) patients in a single institution.
Seventy-five high-risk PCa patients were treated by three-dimensional conformal radiotherapy of 70 Gy combined with neoadjuvant, concurrent and adjuvant ADT.
Median age was 72 (59-82) years. Median initial serum prostate-specific antigen (PSA) was 19.0 (4.7-200) ng/ml. Median duration of the entire ADT was 27 (8-63) months. Median follow-up after initiating ADT and after completing EBRT was 66 (41-105) and 59 (36-94) months, respectively. Five-year overall, clinical progression-free, and biochemical progression-free survival rates were 98.3, 97.2, and 87.4%; 2 (2.7%) cancer deaths, 3 (4.0%) clinical progressions, and 11 (14.7%) biochemical progressions. Multivariate analysis suggested a total duration of ADT shorter than 24 months as an independent risk factor of biochemical progression (p = 0.01). Grade 3 toxicities related to EBRT were observed: 1 patient with proctitis and rectal bleeding and 1 patient with rectal bleeding.
It is suggested that 70 Gy EBRT combined with ADT confers disease-free survival benefit with tolerable adverse events for Japanese high-risk PCa patients. ADT of 24 months or longer might be recommended to minimize biochemical progression.
在单一机构中评估外照射放疗（EBRT）联合雄激素剥夺疗法（ADT）对日本高危前列腺癌（PCa）患者的疗效和毒性。
75例高危PCa患者接受了70 Gy的三维适形放疗，并联合新辅助、同步和辅助ADT。
中位年龄为72（59 - 82）岁。初始血清前列腺特异性抗原（PSA）中位数为19.0（4.7 - 200）ng/ml。整个ADT的中位持续时间为27（8 - 63）个月。开始ADT后和完成EBRT后的中位随访时间分别为66（41 - 105）个月和59（36 - 94）个月。5年总生存率、临床无进展生存率和生化无进展生存率分别为98.3%、97.2%和87.4%；2例（2.7%）癌症死亡，3例（4.0%）临床进展，11例（14.7%）生化进展。多因素分析表明，ADT总持续时间短于24个月是生化进展的独立危险因素（p = 0.01）。观察到与EBRT相关的3级毒性反应：1例患者发生直肠炎和直肠出血，1例患者出现直肠出血。
对于日本高危PCa患者，70 Gy EBRT联合ADT可带来无病生存获益，且不良事件可耐受。可能建议采用24个月或更长时间的ADT以尽量减少生化进展。
