North Coast Cancer Institute, Port Macquarie, NSW, Australia ; The University of New South Wales, Rural Clinical School, Sydney, NSW, Australia.
North Coast Cancer Institute, Coffs Harbour, NSW, Australia ; The University of New South Wales, Rural Clinical School, Sydney, NSW, Australia.
Onco Targets Ther. 2014 Aug 30;7:1519-23. doi: 10.2147/OTT.S65238. eCollection 2014.
Dose-escalated (DE) radiotherapy in the setting of localized prostate cancer has been shown to improve biochemical disease-free survival (bDFS) in several studies. In the same group of patients, androgen deprivation therapy (ADT) has been shown to confer a survival benefit when combined with radiotherapy doses of up to 70 Gy; however, there is currently little long-term data on patients who have received high-dose intensity-modulated radiotherapy (IMRT) with ADT. We report the long-term outcomes in a large cohort of patients treated with the combination of DE image-guided IMRT (IG-IMRT) and ADT.
Patients with localized prostate cancer were identified from a centralized database across an integrated cancer center. All patients received DE IG-IMRT, combined with ADT, and had a minimum follow up of 12 months post-radiotherapy. All relapse and toxicity data were collected prospectively. Actuarial bDFS, metastasis-free survival, prostate cancer-specific survival, and multivariate analyses were calculated using the SPSS v20.0 statistical package.
Seven hundred and eighty-two eligible patients were identified with a median follow up of 46 months. Overall, 4.3% of patients relapsed, 2.0% developed distant metastases, and 0.6% died from metastatic prostate cancer. At 5-years, bDFS was 88%, metastasis-free survival was 95%, and prostate cancer-specific survival was 98%. Five-year grade 2 genitourinary and gastrointestinal toxicity was 2.1% and 3.4%, respectively. No grade 3 or 4 late toxicities were reported. Pretreatment prostate specific antigen (P=0.001) and Gleason score (P=0.03) were significant in predicting biochemical failure on multivariate analysis.
There is a high probability of tumor control with DE IG-IMRT combined with androgen deprivation, and this is a technique with a low probability of significant late toxicity. Our long term results corroborate the safety and efficacy of treating with IG-IMRT to high doses and compares favorably with published series for the treatment of prostate cancer.
在局部前列腺癌中，递增剂量（DE）放疗已被证明可改善几项研究中的生化无病生存期（bDFS）。在同一组患者中，当联合使用 70Gy 及以下放射剂量时，雄激素剥夺疗法（ADT）已被证明具有生存获益；然而，目前关于接受 ADT 高剂量强度调制放疗（IMRT）的患者的长期数据很少。我们报告了一组接受 DE 图像引导调强放疗（IG-IMRT）联合 ADT 治疗的大型患者队列的长期结果。
通过一个综合性癌症中心的中央数据库确定了患有局限性前列腺癌的患者。所有患者均接受 DE IG-IMRT 联合 ADT 治疗，放射治疗后随访时间至少 12 个月。所有复发和毒性数据均前瞻性收集。使用 SPSS v20.0 统计软件包计算了 bDFS、无转移生存率、前列腺癌特异性生存率和多变量分析的累积生存率。
确定了 782 名符合条件的患者，中位随访时间为 46 个月。总体而言，4.3%的患者复发，2.0%发生远处转移，0.6%死于转移性前列腺癌。5 年时，bDFS 为 88%，无转移生存率为 95%，前列腺癌特异性生存率为 98%。5 年时，泌尿生殖系统 2 级毒性和胃肠道毒性分别为 2.1%和 3.4%。未报告 3 级或 4 级晚期毒性。多变量分析显示，治疗前前列腺特异性抗原（PSA）（P=0.001）和 Gleason 评分（P=0.03）是生化失败的显著预测因素。
DE IG-IMRT 联合雄激素剥夺治疗有很高的肿瘤控制概率，且这种技术发生严重晚期毒性的概率较低。我们的长期结果证实了使用 IG-IMRT 进行高剂量治疗的安全性和有效性，并且与治疗前列腺癌的已发表系列结果相比具有优势。
