Department of Radiotherapy Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
Anticancer Res. 2012 Oct;32(10):4561-8.
We evaluated the feasibility and efficacy of postoperative hypofractionated and accelerated radiotherapy supported with amifostine cytoprotection (HypoARC) in patients with high-risk or recurrent prostate cancer.
Fourty-eight patients were recruited (median follow-up=41 months; range=12-84 months). Twenty-one received HypoARC after surgery and 27 at biochemical relapse. Radiotherapy was given with a 3D-conformal technique, delivering 2.7 Gy/day to the pelvis and 3.4 Gy to the peri-prostatic region for 14 fractions. A 15th fraction increased the total dose to the peri-prostatic area to 51 Gy (15×3.4 Gy) in 19 days. Amifostine was delivered before each radiotherapy fraction at an individualized (by tolerance) dose (0-1000 mg).
Amifostine was delivered subcutaneously at 1000 mg in 35/48 (72.9%) patients, while lower doses were tolerated by the remaining patients. Twenty-six (54.2%) patients accomplished therapy without delays, while acute toxicities enforced 1 to 2 week delays in 11/48 patients (22.9%). Grade 2 proctitis was noted in 18.7%, while substantial bleeding occurred in 8.3% of patients. Grade 1 dysurea was noted in 27.1%, while diarrhea grade 2 appeared in 10.4% of patients. High amifostine dose was linked to a significant reduction of proctitis (p=0.04). No severe late toxicities were noted. Within a median of 41 months, 7/48 (14.6%) patients exhibited post-radiotherpy biochemical failure (in four due to metastasis). High-dose (1000 mg) amifostine defined a significantly better outcome (p=0.004), an effect sustained on multivariate analysis.
Postoperative HypoARC is feasible with low-grade early and late toxicities, and emerges as a candidate for evaluation in randomized trials. The three-fold reduction of the overall treatment time renders HypoARC appealing for busy radiotherapy departments.
我们评估了术后低分割加速放疗联合氨磷汀细胞保护（HypoARC）在高危或复发性前列腺癌患者中的可行性和疗效。
共招募了 48 名患者（中位随访时间=41 个月；范围=12-84 个月）。21 名患者在手术后接受 HypoARC，27 名患者在生化复发时接受治疗。放疗采用三维适形技术，骨盆给予 2.7 Gy/天，前列腺周围区域给予 3.4 Gy，共 14 个分次。15 个分次将前列腺周围区域的总剂量增加到 51 Gy（15×3.4 Gy），在 19 天内完成。氨磷汀在每个放疗分次前根据耐受情况（0-1000 mg）给予个体化剂量。
35/48（72.9%）名患者给予氨磷汀 1000 mg 皮下注射，其余患者耐受较低剂量。26 名（54.2%）患者完成了治疗，没有延迟，而 11 名（22.9%）患者因急性毒性需要 1-2 周的延迟。18.7%的患者出现 2 级直肠炎，8.3%的患者出现严重出血。27.1%的患者出现 1 级排尿困难，10.4%的患者出现 2 级腹泻。高剂量氨磷汀与直肠炎显著减少相关（p=0.04）。没有严重的晚期毒性。在中位随访时间为 41 个月时，48 名患者中有 7 名（14.6%）出现放疗后生化失败（其中 4 名因转移）。高剂量（1000 mg）氨磷汀定义了更好的结局（p=0.004），多变量分析结果仍然支持这一结论。
术后低分割加速放疗联合氨磷汀细胞保护具有低级别早期和晚期毒性，并且作为随机试验的候选方案出现。总治疗时间缩短了三倍，这使得 HypoARC 对繁忙的放疗部门具有吸引力。
