Department of Radiooncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
Strahlenther Onkol. 2012 Nov;188(11):982-9. doi: 10.1007/s00066-012-0169-1. Epub 2012 Oct 11.
This study reports on the treatment techniques, toxicity, and outcome of pelvic intensity-modulated radiotherapy (IMRT) for lymph node-positive prostate cancer (LNPPC, T1-4, c/pN1 cM0).
Pelvic IMRT to 45-50.4 Gy was applied in 39 cases either after previous surgery of involved lymph nodes (n = 18) or with a radiation boost to suspicious nodes (n = 21) with doses of 60-70 Gy, usually combined with androgen deprivation (n = 37). The prostate and seminal vesicles received 70-74 Gy. In cases of previous prostatectomy, prostatic fossa and remnants of seminal vesicles were given 66-70 Gy. Treatment-related acute and late toxicity was graded according to the RTOG criteria.
Acute radiation-related toxicity higher than grade 2 occurred in 2 patients (with the need for urinary catheter/subileus related to adhesions after surgery). Late toxicity was mild (grade 1-2) after a median follow-up of 70 months. Over 50% of the patients reported no late morbidity (grade 0). PSA control and cancer-specific survival reached 67% and 97% at over 5 years.
Pelvic IMRT after the removal of affected nodes or with a radiation boost to clinically positive nodes led to an acceptable late toxicity (no grade 3/4 events), thus justifying further evaluation of this approach in a larger cohort.
本研究报告了淋巴结阳性前列腺癌（LNPPC，T1-4，c/pN1 cM0）患者接受盆腔调强放疗（IMRT）的治疗技术、毒性和结果。
39 例患者接受了盆腔 IMRT，照射剂量为 45-50.4Gy，这些患者此前要么接受了受累淋巴结切除术（n=18），要么接受了可疑淋巴结的放疗加量（n=21），加量剂量为 60-70Gy，通常与雄激素剥夺治疗（n=37）联合应用。前列腺和精囊接受 70-74Gy 的照射。对于此前接受过前列腺切除术的患者，给予前列腺窝和精囊残端 66-70Gy 的照射。根据 RTOG 标准对治疗相关的急性和晚期毒性进行分级。
2 例患者（因术后粘连需要导尿/小肠气）出现高于 2 级的急性放射性相关毒性。中位随访 70 个月后，晚期毒性为轻度（1-2 级）。超过 50%的患者报告无晚期并发症（0 级）。超过 5 年时，PSA 控制和癌症特异性生存率分别达到 67%和 97%。
对于清除了受影响淋巴结的患者或对临床阳性淋巴结进行放疗加量的患者，盆腔 IMRT 导致可接受的晚期毒性（无 3/4 级事件），因此有理由在更大的队列中进一步评估这种方法。
