Department of Radiation Oncology, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, Brazil.
Radiat Oncol. 2013 Dec 6;8:285. doi: 10.1186/1748-717X-8-285.
Clinically localized prostate cancer may be treated by different approaches of radiation therapy. The aim of this study was to report the results of disease control and toxicity in patients with clinically localized prostate cancer treated with high dose IMRT alone with 1 cm PTV posterior margin.
From September 2001 to April 2008, 140 patients with localized prostate cancer were treated with definitive IMRT (dose ≥ 74 Gy) without hormone therapy. Outcomes were measured from the conclusion of radiotherapy. Biochemical failure was defined as PSA nadir + 2.0 ng/dL. Toxicities were assessed using the NCI-CTCAE-version 3.0. Median follow-up was 58 months.
Biochemical failure occurred in 13.6% of patients. Actuarial 5-year biochemical control rates were 91.7%, 82.5% and 85.9% for low-, intermediate-, and high-risk patients, respectively. Stage T2 patients presented a risk of biochemical failure almost three times higher than stage T1 (RR = 2.91; 95% CI: 1.04; 8.17). Distant metastases occurred in 3 (2%) patients. Five-year metastasis-free and overall survivals were 96% and 97.5%, respectively. Late grade 3 genitourinary and gastrointestinal toxicity rates were, respectively, 1.6% and 3%.
High-dose IMRT alone with 1 cm posterior PTV margin was effective and safe for patients with localized prostate cancer.
局限性前列腺癌可以通过不同的放射治疗方法进行治疗。本研究旨在报告单纯采用高剂量调强放疗（IMRT）治疗局限性前列腺癌患者的疾病控制和毒性反应结果，PTV 后边界为 1cm。
2001 年 9 月至 2008 年 4 月，140 例局限性前列腺癌患者采用根治性 IMRT（剂量≥74Gy）治疗，未接受激素治疗。结果在放疗结束后进行测量。生化失败定义为 PSA 最低点+2.0ng/dL。采用 NCI-CTCAE 第 3.0 版评估毒性。中位随访时间为 58 个月。
13.6%的患者发生生化失败。低危、中危和高危患者的 5 年生化无控制率分别为 91.7%、82.5%和 85.9%。T2 期患者的生化失败风险是 T1 期的近 3 倍（RR=2.91；95%CI：1.04；8.17）。3 例（2%）患者发生远处转移。5 年无转移生存率和总生存率分别为 96%和 97.5%。晚期泌尿生殖系统和胃肠道毒性 3 级发生率分别为 1.6%和 3%。
对于局限性前列腺癌患者，单纯采用高剂量调强放疗（IMRT）治疗，PTV 后边界为 1cm，具有较好的有效性和安全性。
