Leroy Thomas, Lacornerie Thomas, Bogart Emilie, Nickers Philippe, Lartigau Eric, Pasquier David
Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020, Lille cedex, France.
Department of Radiation Physics, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020, Lille cedex, France.
Radiat Oncol. 2017 Jun 9;12(1):95. doi: 10.1186/s13014-017-0833-9.
Currently, there is no standard option for local salvage treatment for local prostate cancer recurrence after radiotherapy. Our objective was to investigate the feasibility and efficiency of Robotic Stereotactic Body Radiation Therapy (SBRT) in this clinical setting.
METHODS/MATERIALS: We retrospectively reviewed patients who were treated at our institution with SBRT for local prostate cancer recurrence after External Beam Radiation Therapy (EBRT) or brachytherapy. Multidisciplinary staff approved the treatment, and recurrence was biopsy-proven when feasible. A dose of 36 Gy was prescribed in six fractions. Treatment was delivered every other day.
Between August 2011 and February 2014, 23 patients were treated with SBRT for intra-prostate cancer recurrence with a median follow up of 22 months (6 to 40). Twenty patients had biopsy-proven recurrence. For 19 patients, EBRT was the initial treatment and in four patients, brachytherapy was the initial treatment; the median relapse-time from initial treatment was 65 months (28 to 150). At relapse, 10 patients had an extra-capsular extension. Fourteen patients were treated with androgen deprivation that could be stopped after a median of 1 month after SBRT (range 0-24). A PSA decrease occurred in 82.6% of the patients after SBRT. The 2-year disease-free survival and overall survival rates were 54 and 100%, respectively. Disease progression was observed for nine patients (39.1%) (five local, three metastatic and one nodal progression) after a median of 20 months (7-40 months). The median nadir PSA was 0.35 ng/ml and was achieved after a median of 8 months (1 to 30) after treatment. We observed no grade 4 or 5 toxicity. Two patients presented with grade 3 toxicities (two Cystitis and one neuralgia). Other toxicities included urinary toxicities (five grade 2 and nine grade 1) and rectal toxicities (two grade 2 and two grade 1).
SBRT for local prostate cancer recurrence seems feasible and well tolerated with a short follow up. Prospective evaluation is needed.
目前，对于放疗后局部前列腺癌复发的局部挽救治疗尚无标准方案。我们的目的是研究机器人立体定向体部放射治疗（SBRT）在这种临床情况下的可行性和有效性。
方法/材料：我们回顾性分析了在我院接受SBRT治疗的局部前列腺癌复发患者，这些患者之前接受过外照射放疗（EBRT）或近距离放射治疗。多学科团队批准了该治疗方案，可行时通过活检证实复发。处方剂量为36 Gy，分6次给予。治疗每隔一天进行一次。
2011年8月至2014年2月期间，23例患者接受了SBRT治疗前列腺内癌复发，中位随访时间为22个月（6至40个月）。20例患者经活检证实复发。19例患者初始治疗为EBRT，4例患者初始治疗为近距离放射治疗；从初始治疗到复发的中位时间为65个月（28至150个月）。复发时，10例患者有包膜外侵犯。14例患者接受了雄激素剥夺治疗，SBRT后中位1个月（范围0至24个月）可停止治疗。SBRT后82.6%的患者前列腺特异性抗原（PSA）下降。2年无病生存率和总生存率分别为54%和100%。中位20个月（7至40个月）后，9例患者（39.1%）出现疾病进展（5例局部进展、3例转移和1例淋巴结进展）。中位最低PSA为0.35 ng/ml，治疗后中位8个月（1至30个月）达到。我们未观察到4级或5级毒性反应。2例患者出现3级毒性反应（2例膀胱炎和1例神经痛）。其他毒性反应包括泌尿系统毒性反应（5例2级和9例1级）和直肠毒性反应（2例2级和2例1级）。
对于局部前列腺癌复发，SBRT似乎可行且耐受性良好，但随访时间较短。需要进行前瞻性评估。
