Petrongari Maria Grazia, Landoni Valeria, Saracino Biancamaria, Gomellini Sara, Arcangeli Stefano, Iaccarino Giuseppe, Pinnarò Paola, Arcangeli Giorgio, Strigari Lidia
Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy.
J Exp Clin Cancer Res. 2013 Dec 13;32(1):103. doi: 10.1186/1756-9966-32-103.
To investigate the feasibility of dose escalation (86 Gy at 2 Gy/fraction) with intensity modulated radiation therapy (IMRT) in intermediate-risk prostate cancer without androgen deprivation therapy.
Patients with histologically proven adenocarcinoma of the prostate, intermediate prognostic category, were enrolled in this study. Early and late toxicity were scored according to the Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0. Treatment outcome was stated in terms of biochemical failure, biopsy result and clinical failure.
39 patients with a median follow-up of 71 months were analyzed. No patient experienced G3 or G4 acute gastrointestinal (GI) or genitourinary (GU) toxicity. G2 acute GI and GU toxicity were observed in 17 (44%) and 20 (51%) patients, respectively. Fourteen patients (36%) did not experience acute GI toxicity and 4 patients (10%) did not experience acute GU toxicity. G2 late GI bleeding occurred in 7 of 39 patients (18%). Both G3 and G4 late GI toxicity were seen only in one patient (2.5%). Two patients (5%) experienced G2 late GU toxicity, while G3 late GU toxicity occurred in 3 patients (8%). The 5-year actuarial freedom from biochemical failure (FFBF) was 87%. Thirty-four patients (87%) did not show biochemical relapse. Seventeen patients (44%) underwent biopsy two year after radiotherapy; of these only two were non-negative and both did not show evidence of biochemical disease.
IMRT treatment of patients with localized intermediate-risk prostate cancer at high dose levels without using androgen deprivation therapy (ADT) seems to give good disease control. Nevertheless, future trials should aim at further decreasing toxicity by exploiting image guidance techniques and by reducing the dose delivered at the interface between organs at risk and prostate.
探讨在无雄激素剥夺治疗的情况下，采用调强放射治疗（IMRT）对中度风险前列腺癌进行剂量递增（86 Gy，每次分割剂量2 Gy）的可行性。
组织学确诊为前列腺腺癌且预后为中度的患者纳入本研究。根据癌症治疗评估计划、不良事件通用术语标准第3.0版对早期和晚期毒性进行评分。治疗结果以生化失败、活检结果和临床失败来表述。
分析了39例患者，中位随访时间为71个月。没有患者出现3级或4级急性胃肠道（GI）或泌尿生殖系统（GU）毒性。分别有17例（44%）和20例（51%）患者出现2级急性GI和GU毒性。14例患者（36%）未出现急性GI毒性，4例患者（10%）未出现急性GU毒性。39例患者中有7例（18%）出现2级晚期GI出血。3级和4级晚期GI毒性仅在1例患者（2.5%）中出现。2例患者（5%）出现2级晚期GU毒性，3例患者（分别为8%）出现3级晚期GU毒性。5年生化无进展生存率（FFBF）为87%。34例患者（87%）未出现生化复发。17例患者（44%）在放疗后两年接受了活检；其中只有2例活检结果为非阴性，且均未显示出生化疾病的证据。
在不使用雄激素剥夺治疗（ADT）的情况下，对局部中度风险前列腺癌患者进行高剂量水平的IMRT治疗似乎能实现良好的疾病控制。然而，未来的试验应旨在通过利用图像引导技术和减少危及器官与前列腺之间界面处的照射剂量来进一步降低毒性。
