Faria Sergio, Ruo Russel, Cury Fabio, Duclos Marie, Souhami Luis
McGill University Health Centre, Department of Radiation Oncology, Montreal, Quebec, Canada.
McGill University Health Centre, Department of Medical Physics, Montreal, Quebec, Canada.
Pract Radiat Oncol. 2017 Jul-Aug;7(4):264-269. doi: 10.1016/j.prro.2017.01.003. Epub 2017 Jan 20.
To report acute and late toxicity rates in patients with high-risk prostate cancer treated with androgen deprivation therapy (ADT) and moderate hypofractionated radiation therapy (HypoRT) to the prostate and nodal areas.
Patients with localized, high-risk prostate cancer were treated with a HypoRT regimen of 60 Gy in 20 fractions (4 weeks) to the prostate volume while the nodal areas received 44 Gy in the same 20 fractions delivered with intensity modulated RT with a simultaneous integrated boost technique. ADT started 2 to 3 months before HypoRT and was given to all patients. Acute and late toxicity were prospectively assessed and graded according to the Common Terminology Criteria for Adverse Events, version 3.
A total of 105 patients treated between September 2010 and November 2013 were reviewed. Median follow-up was 41 months, with 97% of patients followed for more than 26 months. Median ADT duration was 18 months. Acute grade 2 or higher gastrointestinal (GI) or genitourinary (GU) toxicity was seen in 18 (17%) and 19 (17%) patients, respectively, with only 1 and 3 patients experiencing either a GI or GU acute grade 3 toxicity. The worst grade 2 or higher late GI and GU toxicity were seen in 7 (7%) and 8 (8%) patients, respectively. There was no grade 4 or 5 toxicity. At the last follow-up, the rate of grade 2 GI and GU toxicity was 5% and 3%, respectively, with no residual grade ≥3 toxicity. The 48-month actuarial progression free survival is 82%.
ADT with moderate HypoRT delivered with IMRT and an integrated simultaneous boost to the prostate (60 Gy) and pelvic nodes (44 Gy) in 20 fractions is feasible and well tolerated. This approach shortens treatment duration and is convenient for patients and the health system, and its results support a randomized trial.
报告接受雄激素剥夺疗法（ADT）联合中度超分割放射治疗（HypoRT）至前列腺及淋巴结区域的高危前列腺癌患者的急性和晚期毒性发生率。
局部高危前列腺癌患者接受HypoRT方案，对前列腺体积给予60 Gy分20次（4周）照射，同时对淋巴结区域在相同的20次照射中给予44 Gy，采用调强放疗及同步整合加量技术。ADT在HypoRT前2至3个月开始，所有患者均接受。根据不良事件通用术语标准第3版对急性和晚期毒性进行前瞻性评估和分级。
回顾了2010年9月至2013年11月期间治疗的105例患者。中位随访时间为41个月，97%的患者随访时间超过26个月。ADT的中位持续时间为18个月。分别有18例（17%）和19例（17%）患者出现急性2级或更高等级的胃肠道（GI）或泌尿生殖系统（GU）毒性，仅有1例和3例患者分别出现GI或GU急性3级毒性。分别有7例（7%）和8例（8%）患者出现最严重的2级或更高等级晚期GI和GU毒性。无4级或5级毒性。在最后一次随访时，2级GI和GU毒性发生率分别为5%和3%，无残留≥3级毒性。48个月的无进展生存率为82%。
ADT联合IMRT进行中度HypoRT，对前列腺（60 Gy）和盆腔淋巴结（44 Gy）分20次同步整合加量是可行的，耐受性良好。这种方法缩短了治疗时间，对患者和卫生系统都很方便，其结果支持进行随机试验。
