Department of Radiation-Oncology, Ghent University Hospital, Belgium.
Radiother Oncol. 2013 Nov;109(2):229-34. doi: 10.1016/j.radonc.2013.08.006. Epub 2013 Sep 7.
For patients with N1 prostate cancer (PCa) aggressive local therapies can be advocated. We evaluated clinical outcome, gastro-intestinal (GI) and genito-urinary (GU) toxicity after intensity modulated arc radiotherapy (IMAT)+androgen deprivation (AD) for N1 PCa.
Eighty patients with T1-4N1M0 PCa were treated with IMAT and 2-3years of AD. A median dose of 69.3Gy (normalized isoeffective dose at 2Gy per fraction: 80Gy [α/β=3]) was prescribed in 25 fractions to the prostate. The pelvic lymph nodes received a minimal dose of 45Gy. A simultaneous integrated boost to 72Gy and 65Gy was delivered to the intraprostatic lesion and/or pathologically enlarged lymph nodes, respectively. GI and GU toxicity was scored using the RTOG/RILIT and RTOG-SOMA/LENT-CTC toxicity scoring system respectively. Three-year actuarial risk of grade 2 and 3/4 GI-GU toxicity and biochemical and clinical relapse free survival (bRFS and cRFS) were calculated with Kaplan-Meier statistics.
Median follow-up was 36months. Three-year actuarial risk for late grade 3 and 2 GI toxicity is 8% and 20%, respectively. Three-year actuarial risk for late grade 3-4 and 2 GU toxicity was 6% and 34%, respectively. Actuarial 3-year bRFS and cRFS was 81% and 89%, respectively. Actuarial 3-year bRFS and cRFS was, respectively 26% and 32% lower for patients with cN1 disease when compared to patients with cN0 disease.
IMAT for N1 PCa offers good clinical outcome with moderate toxicity. Patients with cN1 disease have poorer outcome.
对于 N1 期前列腺癌（PCa）患者，可以提倡采用强化局部治疗。我们评估了 N1 期 PCa 患者接受调强弧形放疗（IMAT）+雄激素剥夺（AD）治疗后的临床结局、胃肠道（GI）和泌尿生殖系统（GU）毒性。
80 例 T1-4N1M0 PCa 患者接受 IMAT 和 2-3 年 AD 治疗。前列腺给予 25 个分次的 69.3Gy 中位剂量（2Gy 等效剂量归一化：80Gy [α/β=3]）。盆腔淋巴结给予 45Gy 的最小剂量。对前列腺内病变和/或病理性肿大的淋巴结分别给予 72Gy 和 65Gy 的同步整合增敏。GI 和 GU 毒性分别采用 RTOG/RILIT 和 RTOG-SOMA/LENT-CTC 毒性评分系统进行评分。采用 Kaplan-Meier 统计计算 3 年生化无复发生存（bRFS）和临床无复发生存（cRFS）的 2 级和 3/4 级 GI-GU 毒性及生化和临床复发的 3 年累积发生率。
中位随访时间为 36 个月。3 年时晚期 3 级和 2 级 GI 毒性的累积发生率分别为 8%和 20%。3 年时晚期 3-4 级和 2 级 GU 毒性的累积发生率分别为 6%和 34%。3 年时 bRFS 和 cRFS 的累积发生率分别为 81%和 89%。与 cN0 患者相比，cN1 疾病患者的 3 年 bRFS 和 cRFS 分别降低了 26%和 32%。
IMAT 治疗 N1 PCa 具有良好的临床疗效，且毒性适中。cN1 疾病患者的预后较差。
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