Ricco Anthony, Manahan Genevieve, Lanciano Rachelle, Hanlon Alexandra, Yang Jun, Arrigo Stephen, Lamond John, Feng Jing, Mooreville Michael, Garber Bruce, Brady Luther
Philadelphia Cyberknife, Delaware County Memorial Hospital , Havertown, PA , USA.
Philadelphia Cyberknife, Delaware County Memorial Hospital, Havertown, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA.
Front Oncol. 2016 Aug 23;6:184. doi: 10.3389/fonc.2016.00184. eCollection 2016.
The primary objective of this study is to compare freedom from biochemical failure (FFBF) between stereotactic body radiation therapy (SBRT) and intensity-modulated radiation therapy (IMRT) for patients with organ confined prostate cancer treated between 2007 through 2012 utilizing the 2015 National Comprehensive Cancer Network (NCCN) risk stratification guidelines. A secondary objective is to compare our updated toxicity at last follow-up compared with pretreatment with respect to bowel, bladder, sexual functioning, and need for invasive procedures between the two groups.
We retrospectively reviewed 270 consecutive men treated with either SBRT (n = 150) or IMRT (n = 120) at a community hospital with two distinct radiation departments and referral patterns. Charts were reviewed for pretreatment and treatment factors including race, age, clinical T stage, initial PSA, Gleason score, use of androgen deprivation therapy, treatment with SBRT vs. IMRT, as well as stratification by 2015 NCCN guidelines. Kaplan-Meier (KM) methodology was used to estimate FFBF, with statistical comparisons accomplished using log rank tests. Multivariable Cox proportional hazard modeling was used to establish independent factors prognostic of biochemical failure. Descriptive statistics were used to describe toxicity graded by a modified Radiation Therapy Oncology Group (RTOG) late radiation morbidity scoring system.
Significant prognostic factors in univariate analysis for FFBF included NCCN risk groups (p = 0.0032), grade (p = 0.019), and PSA (p = 0.008). There was no significant difference in FFBF between SBRT vs. IMRT (p = 0.46) with 6-year actuarial FFBF of 91.9% for SBRT and 88.9% for IMRT. Multivariable analysis revealed only the NCCN risk stratification to be significant predictor for FFBF (p = 0.04). Four-year actuarial FFBF by NCCN risk stratification was 100% very low risk, 100% low risk, 96.5% intermediate risk, 94.5% high risk, and 72.7% very high risk. There were no grade 3 gastrointestinal or genitourinary toxicities for either SBRT or IMRT at last follow-up.
No significant difference in FFBF was found between SBRT and IMRT for organ confined prostate cancer in multivariable analysis within this retrospective data set. Overall toxicity was low. The 2015 NCCN risk stratification was validated in this population and was the only significant factor for FFBF in multivariable analysis.
本研究的主要目的是利用2015年美国国立综合癌症网络（NCCN）风险分层指南，比较2007年至2012年期间接受治疗的器官局限性前列腺癌患者在立体定向体部放射治疗（SBRT）和调强放射治疗（IMRT）后的无生化失败生存期（FFBF）。次要目的是比较两组在末次随访时相对于治疗前在肠道、膀胱、性功能以及侵入性操作需求方面的毒性更新情况。
我们回顾性分析了一家社区医院两个不同放射科及转诊模式下连续接受SBRT（n = 150）或IMRT（n = 120）治疗的270例男性患者。查阅病历以获取治疗前和治疗相关因素，包括种族、年龄、临床T分期、初始前列腺特异抗原（PSA）、Gleason评分、雄激素剥夺治疗的使用、SBRT与IMRT治疗情况，以及按照2015年NCCN指南进行的分层。采用Kaplan-Meier（KM）方法估计FFBF，使用对数秩检验进行统计学比较。多变量Cox比例风险模型用于确定生化失败的独立预后因素。描述性统计用于描述采用改良放射肿瘤学组（RTOG）晚期放射发病率评分系统分级的毒性情况。
单变量分析中FFBF的显著预后因素包括NCCN风险组（p = 0.0032）、分级（p = 0.019）和PSA（p = 0.008）。SBRT与IMRT之间的FFBF无显著差异（p = 0.46），SBRT的6年精算FFBF为91.9%，IMRT为88.9%。多变量分析显示只有NCCN风险分层是FFBF的显著预测因素（p = 0.04）。按NCCN风险分层的4年精算FFBF分别为：极低风险100%、低风险100%、中风险96.5%、高风险94.5%、极高风险72.7%。末次随访时SBRT和IMRT均未出现3级胃肠道或泌尿生殖系统毒性。
在该回顾性数据集中的多变量分析中，SBRT和IMRT治疗器官局限性前列腺癌的FFBF无显著差异。总体毒性较低。2015年NCCN风险分层在该人群中得到验证，并且是多变量分析中FFBF的唯一显著因素。
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