*Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Jpn J Clin Oncol. 2014 Feb;44(2):180-5. doi: 10.1093/jjco/hyt197. Epub 2013 Dec 29.
There are few reports of the outcomes of external beam radiotherapy in Asian males with localized prostate cancer. The aim of this study is to evaluate the long-term outcomes of external beam irradiation using three-dimensional two-dynamic conformal arc therapy, combined with neoadjuvant hormonal therapy, in patients with T1c-T2N0M0 prostate cancer.
Between March 2003 and August 2007, 150 Japanese patients with T1c-T2N0M0 prostate cancer were definitively treated with three-dimensional two-dynamic conformal arc therapy. The median age, pretreatment prostate-specific antigen values and neoadjuvant hormonal therapy period were 73 years, 9.4 ng/ml and 6 months, respectively. In principle, 74 Gy was delivered to the planning target volume, although the total dose was reduced to 70 Gy in patients with unfavorable risk factors, such as severe diabetes mellitus or anticoagulant therapy. No adjuvant hormonal therapy was given to any patient. Salvage hormonal therapy was started when the prostate-specific antigen value exceeded 4 ng/ml in a monotonically increasing manner.
The median follow-up period was 79 months. Salvage hormonal therapy was initiated in 10 patients and the median prostate-specific antigen value at the initiation was 4.7 ng/ml. The 5-year Kaplan-Meier estimates of the biochemical relapse-free survival rate, the salvage hormonal therapy -free rate and the overall survival rate were 83.3% (95% confidence interval = 77.1-89.6%), 94.3% (95% confidence interval = 90.4-98.1%) and 96.3% (95% confidence interval = 93.1-99.5%), respectively. The 5-year cumulative incidence rates of developing more than Grade 2 late rectal and urinary toxicities were 5.5 and 2.9%, respectively.
Three-dimensional two-dynamic conformal arc therapy, with up to 74 Gy, in patients with T1c-T2N0M0 prostate cancer with neoadjuvant hormonal therapy was well tolerated and achieved good biochemical control and survival outcomes.
亚洲男性局限性前列腺癌的外照射放疗结果鲜有报道。本研究旨在评估新辅助激素治疗联合三维两动态适形弧形放疗治疗 T1c-T2N0M0 前列腺癌患者的长期疗效。
2003 年 3 月至 2007 年 8 月，150 例 T1c-T2N0M0 前列腺癌日本患者接受了三维两动态适形弧形放疗。中位年龄、治疗前前列腺特异性抗原值和新辅助激素治疗期分别为 73 岁、9.4ng/ml 和 6 个月。原则上，计划靶区给予 74Gy，但对于有不利危险因素的患者（如严重糖尿病或抗凝治疗），总剂量降至 70Gy。无患者接受辅助激素治疗。当前列腺特异性抗原值呈单调递增且超过 4ng/ml 时，开始进行挽救性激素治疗。
中位随访时间为 79 个月。10 例患者开始进行挽救性激素治疗，起始时前列腺特异性抗原值中位数为 4.7ng/ml。生化无复发生存率、挽救性激素治疗无失败率和总生存率的 5 年 Kaplan-Meier 估计值分别为 83.3%（95%置信区间为 77.1%-89.6%）、94.3%（95%置信区间为 90.4%-98.1%）和 96.3%（95%置信区间为 93.1%-99.5%）。发生 2 级以上晚期直肠和泌尿系统毒性的 5 年累积发生率分别为 5.5%和 2.9%。
接受新辅助激素治疗的 T1c-T2N0M0 前列腺癌患者接受 74Gy 以内的三维两动态适形弧形放疗具有良好的耐受性，实现了良好的生化控制和生存结局。
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