National Institute for Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan.
Cancer Treat Rev. 2013 Dec;39(8):872-8. doi: 10.1016/j.ctrv.2013.04.003. Epub 2013 May 3.
The prognosis of high-risk prostate cancer is poor with a high mortality rate. The Radiation Therapy Oncology Group (RTOG) has performed dose-escalation studies of external beam radiation therapy (EBRT) and has developed high-precision radiation therapy (RT) methods such as intensity-modulated RT, carbon ion therapy, and proton beam therapy. High-dose rate brachytherapy (HDR-BT) is also studied as an option for high-risk prostate cancer treatment. Past clinical trials have suggested that the local control rate of high-risk prostate cancer improves with total EBRT dose, even for doses > 70 Gy. Several randomized controlled trials, including RTOG 94-06, have shown significantly better prognoses with higher doses (> 75 Gy) than with lower doses (< 70 Gy). A proton beam therapy trial (PROG 95-09) also showed similar results. A phase II clinical trial (National Institute for Radiological Sciences, Japan; trial 9904) showed that carbon ion therapy resulted in very good biochemical recurrence-free survival rates among high-risk prostate cancer patients, demonstrating particle therapy to be a valid treatment option. RTOG 86-10 showed that short-term neo-adjuvant hormonal therapy (HT) was inadequate for high-risk prostate cancer but effective for intermediate-risk prostate cancer, whereas RTOG 92-02 and the European Organisation for Research and Treatment of Cancer (EORTC) 22863 showed significant improvements in the prognosis of high-risk groups receiving long-term (> 2 years) HT combined with definitive RT. Further studies are warranted to elucidate optimal irradiation doses, HT treatment durations, and combination therapy schedules.
高危前列腺癌的预后较差，死亡率较高。放射治疗肿瘤学组（RTOG）已经进行了外部束放射治疗（EBRT）的剂量递增研究，并开发了高强度调强放射治疗（IMRT）、碳离子治疗和质子束治疗等高精度放射治疗方法。高剂量率近距离放射治疗（HDR-BT）也被研究作为高危前列腺癌治疗的一种选择。过去的临床试验表明，高危前列腺癌的局部控制率随着总 EBRT 剂量的增加而提高，即使剂量超过 70Gy。几项随机对照试验，包括 RTOG 94-06，表明高剂量（>75Gy）比低剂量（<70Gy）具有更好的预后。一项质子束治疗试验（PROG 95-09）也显示了类似的结果。一项 II 期临床试验（日本国立放射科学研究所；试验 9904）表明，碳离子治疗在高危前列腺癌患者中导致非常好的生化无复发生存率，证明粒子治疗是一种有效的治疗选择。RTOG 86-10 表明，短期新辅助激素治疗（HT）对高危前列腺癌无效，但对中危前列腺癌有效，而 RTOG 92-02 和欧洲癌症研究与治疗组织（EORTC）22863 表明，长期（>2 年）HT 联合确定性 RT 治疗高危组的预后显著改善。需要进一步研究以阐明最佳照射剂量、HT 治疗持续时间和联合治疗方案。
