局限性外照射治疗去势抵抗性前列腺癌的长期疗效。
Long-term outcomes of definitive external-beam radiotherapy for non-metastatic castration-resistant prostate cancer.
机构信息
Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
出版信息
Int J Clin Oncol. 2018 Aug;23(4):749-756. doi: 10.1007/s10147-018-1265-8. Epub 2018 Mar 19.
BACKGROUND
Although definitive external-beam radiotherapy (EBRT) is one of the treatment options for non-metastatic castration-resistant prostate cancer (NM-CRPC), there are limited data on the long-term outcomes of this treatment.
METHODS
We retrospectively evaluated 31 NM-CRPC patients consecutively treated with definitive EBRT. The median age was 74 years upon EBRT initiation. The initial T stage distribution was as follows: T1c in 3, T2 in 11, T3 in 14, and T4 in 3 cases, respectively. The median prostate dose was 70.4 Gy. A castration-resistant status was defined as continuously increasing serum prostate-specific antigen levels despite ongoing hormonal therapy (HT).
RESULTS
The median follow-up duration after EBRT was 66.6 months. The median period of primary HT was 18.0 months. The 5- and 8-year overall survival rates were 74.6 and 49.8%, respectively. The 5- and 8-year prostate cancer-specific survival rates were 77.4 and 51.7%, respectively. Fourteen patients died, and prostate cancer was the cause of death in 12 of these patients. The 5- and 8-year relapse-free survival rates were 32.3 and 25.8%, respectively. Among 23 patients who experienced biochemical or clinical failure, the median duration to recurrence after EBRT was 19.3 months. The 5- and 8-year clinical failure-free survival rates were 56.0 and 51.4%, respectively. Among the 14 patients who experienced clinical failure, the median duration after EBRT was 16.0 months. The local relapse-free rates at 5 and 8 years were 91.0 and 91.0%, respectively. Grade 3 or higher adverse events were observed in four patients.
CONCLUSION
Definitive EBRT achieved a long-term disease-free and clinical failure-free status in approximately one-third of and half of the treated NM-CRPC patients, respectively. This approach was also associated with favorable local relapse-free rates and overall survival outcomes. Definitive EBRT is a promising approach for NM-CRPC patients.
背景
虽然根治性外束放射治疗（EBRT）是治疗非转移性去势抵抗性前列腺癌（NM-CRPC）的一种选择，但关于这种治疗的长期结果的数据有限。
方法
我们回顾性评估了 31 例连续接受根治性 EBRT 的 NM-CRPC 患者。EBRT 开始时的中位年龄为 74 岁。初始 T 分期分布如下：T1c 3 例，T2 11 例，T3 14 例，T4 3 例。中位前列腺剂量为 70.4Gy。去势抵抗状态定义为尽管持续进行激素治疗（HT），但血清前列腺特异性抗原水平持续升高。
结果
EBRT 后中位随访时间为 66.6 个月。中位原发性 HT 时间为 18.0 个月。5 年和 8 年总生存率分别为 74.6%和 49.8%。5 年和 8 年前列腺癌特异性生存率分别为 77.4%和 51.7%。14 例患者死亡，其中 12 例死于前列腺癌。5 年和 8 年无复发生存率分别为 32.3%和 25.8%。在 23 例生化或临床失败的患者中，EBRT 后复发的中位时间为 19.3 个月。5 年和 8 年临床无失败生存率分别为 56.0%和 51.4%。在 14 例临床失败的患者中，EBRT 后中位时间为 16.0 个月。5 年和 8 年局部无复发生存率分别为 91.0%和 91.0%。4 例患者出现 3 级或以上不良事件。
结论
根治性 EBRT 使大约三分之一和一半的 NM-CRPC 患者分别获得了长期无疾病和无临床失败状态。这种方法还与良好的局部无复发生存率和总生存结果相关。根治性 EBRT 是 NM-CRPC 患者的一种有前途的治疗方法。
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