Gladwish A, Loblaw A, Cheung P, Morton G, Chung H, Deabreu A, Pang G, Mamedov A
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Institute for Health Policy, Measurement and Evaluation, University of Toronto, Toronto, Canada.
Clin Oncol (R Coll Radiol). 2015 Mar;27(3):145-52. doi: 10.1016/j.clon.2014.12.003. Epub 2015 Jan 7.
To present the initial findings of a single institution, phase I/II study investigating hypofractionated radiotherapy in patients undergoing post-prostatectomy treatment.
Patients requiring postoperative radiotherapy were prospectively enrolled. Dose was prescribed to the prostate bed with 51 Gy in 17 daily fractions. Androgen deprivation was optional. Acute and late gastrointestinal/genitourinary toxicity were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 and quality of life was assessed using the Expanded Prostate Cancer Index Composite evaluation tool. Prostate-specific antigen (PSA) was evaluated at every follow-up.
Thirty patients were enrolled between 2009 and 2011. The median age was 65 years and most had Gleason 7 disease (86%) with pT2c or pT3a (82%). Positive margins were documented in 67% of the patients. The median pre-treatment PSA was 0.12 ng/ml. The median follow-up was 24 months. Overall toxicity was low, with >80% of patients having ≤ grade 1 acute toxicity in both genitourinary and gastrointestinal realms. Similarly, only two patients (6%) experienced grade 2/3 late gastrointestinal/genitourinary toxicity. Quality of life scores were also indicative of a well-tolerated treatment. PSA failure was seen in five patients (17%).
We present a hypofractionated schedule of postoperative prostate radiotherapy that is both well tolerated in terms of both toxicity and quality of life measures. Initial PSA control is encouraging. Further evaluation with a longer follow-up and a larger cohort is warranted.
介绍一项单机构的I/II期研究的初步结果，该研究调查前列腺切除术后患者的大分割放疗。
前瞻性纳入需要术后放疗的患者。前列腺床的处方剂量为51 Gy，分17次每日照射。雄激素剥夺治疗为可选方案。使用美国国立癌症研究所不良事件通用术语标准3.0版评估急性和晚期胃肠道/泌尿生殖系统毒性，并使用扩展前列腺癌指数综合评估工具评估生活质量。每次随访时评估前列腺特异性抗原（PSA）。
2009年至2011年期间共纳入30例患者。中位年龄为65岁，大多数患者为Gleason 7级疾病（86%），pT2c或pT3a期（82%）。67%的患者有切缘阳性记录。治疗前PSA的中位值为0.12 ng/ml。中位随访时间为24个月。总体毒性较低，超过80%的患者在泌尿生殖系统和胃肠道方面的急性毒性均≤1级。同样，只有两名患者（6%）出现2/3级晚期胃肠道/泌尿生殖系统毒性。生活质量评分也表明该治疗耐受性良好。5例患者（17%）出现PSA失败。
我们提出了一种术后前列腺放疗的大分割方案，该方案在毒性和生活质量方面耐受性良好。初步的PSA控制情况令人鼓舞。有必要进行更长时间随访和更大样本量的进一步评估。
