Daoud Mohamed A, Aboelnaga Engy M, Alashry Mohamed S, Fathy Salwa, Aletreby Mostafa A
Department of Clinical Oncology and Nuclear Medicine, Mansoura Faculty of Medicine, Mansoura University, Mansoura.
Department of Oncology, Fakeeh Hospital, Jeddah, Saudi Arabia.
Onco Targets Ther. 2017 Oct 12;10:4981-4988. doi: 10.2147/OTT.S141224. eCollection 2017.
The role of dose escalation in patients receiving long-term androgen deprivation therapy (ADT) is still a controversial issue. The aim of the current study was to evaluate whether dose escalation for ≥76-80 Gy had any advantage in terms of biochemical disease-free survival (BDFS), distant metastasis-free survival (DMFS), or overall survival outcomes over the dose levels from 70 to <76 Gy.
The study included a cohort of 24 patients classified with high- and intermediate-risk localized prostate cancer. All patients received ADT, starting at 4-6 months before radiation therapy and continued for a total period of 12-24 months in high-risk patients. The treatment plan was given in two phases. In the first phase, the nodal planning target volume (PTV) and the prostate PTV received 48.6 and 54 Gy, respectively, over 27 fractions. The treatment was applied through intensity-modulated radiation therapy or volumetric modulated arc therapy with a simultaneous integrated boost technique.
More than half of the patients were in T3-T4 stage, 79.1% of the patients were in the high-risk category, and all patients received ADT. The rate of acute grade II gastrointestinal and genitourinary toxicities in all patients were 41.7% and 62.5%, respectively. The rate of freedom from grade II rectal toxicity at 2 years was 89% and 83% for patients treated with dose levels <76 and ≥76 Gy, respectively. The rate of BDFS at 2 years was 90% and 85% for doses <76 and ≥76 Gy, respectively. The DMFS at 2 years was 100% and 76% for dose levels <76 and ≥76 Gy, respectively.
In the current study, there were no significant differences in the BDFS and DMFS between patients treated with a dose of <76 and ≥76 Gy, including elective pelvic lymph nodes irradiation combined with ADT.
在接受长期雄激素剥夺治疗（ADT）的患者中，剂量递增的作用仍是一个有争议的问题。本研究的目的是评估与70至<76 Gy剂量水平相比，≥76 - 80 Gy的剂量递增在生化无病生存期（BDFS）、远处转移无病生存期（DMFS）或总生存结局方面是否具有任何优势。
该研究纳入了一组24例高危和中危局限性前列腺癌患者。所有患者均接受ADT，在放疗前4 - 6个月开始，高危患者持续12 - 24个月。治疗计划分两个阶段进行。在第一阶段，淋巴结计划靶体积（PTV）和前列腺PTV分别在27次分割中接受48.6 Gy和54 Gy的照射。治疗通过调强放射治疗或容积调强弧形治疗以及同步整合加量技术进行。
超过一半的患者处于T3 - T4期，79.1%的患者属于高危类别，所有患者均接受了ADT。所有患者中急性II级胃肠道和泌尿生殖系统毒性发生率分别为41.7%和62.5%。接受<76 Gy和≥76 Gy剂量水平治疗的患者，2年时II级直肠毒性无发生率分别为89%和83%。2年时BDFS发生率，<76 Gy和≥76 Gy剂量分别为90%和85%。2年时DMFS发生率，<76 Gy和≥76 Gy剂量水平分别为100%和76%。
在本研究中，接受<76 Gy和≥76 Gy剂量（包括选择性盆腔淋巴结照射联合ADT）治疗的患者在BDFS和DMFS方面无显著差异。
