Benjamin Linus C, Tree Alison C, Dearnaley David P
Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton Surrey, SM2 5PT, London, UK.
Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Downs Road, Sutton Surrey, SM2 5PT, London, UK.
Curr Oncol Rep. 2017 Apr;19(4):30. doi: 10.1007/s11912-017-0584-7.
It is now accepted that prostate cancer has a low alpha/beta ratio, establishing a strong basis for hypofractionation of prostate radiotherapy. This review focuses on the rationale for hypofractionation and presents the evidence base for establishing moderate hypofractionation for localised disease as the new standard of care. The emerging evidence for extreme hypofractionation in managing localized and oligometastatic prostate cancer is reviewed.
The 5-year efficacy and toxicity outcomes from four phase III studies have been published within the last 12 months. These studies randomizing over 6000 patients to conventional fractionation (1.8-2.0 Gy per fraction) or moderate hypofractionation (3.0-3.4 Gy per fraction). They demonstrate hypofractionation to be non-inferior to conventional fractionation. Moderate hypofractionation for localized prostate cancer is safe and effective. There is a growing body of evidence in support of extreme hypofractionation for localized prostate cancer. Extreme hypofractionation may have a role in managing prostate oligometastases, but further studies are needed.
目前已公认前列腺癌具有较低的α/β比值，这为前列腺癌放疗的大分割提供了坚实基础。本综述重点探讨大分割的理论依据，并阐述将局部疾病的适度大分割确立为新的标准治疗方案的证据基础。对局部和寡转移前列腺癌管理中极短程大分割的新出现证据进行综述。
在过去12个月内已发表了四项III期研究的5年疗效和毒性结果。这些研究将6000多名患者随机分为传统分割（每次1.8 - 2.0 Gy）或适度大分割（每次3.0 - 3.4 Gy）。结果表明大分割并不劣于传统分割。局部前列腺癌的适度大分割是安全有效的。越来越多的证据支持局部前列腺癌的极短程大分割。极短程大分割可能在前列腺寡转移的管理中发挥作用，但还需要进一步研究。
