Miszczyk Leszek, Napieralska Aleksandra, Namysł-Kaletka Agnieszka, Woźniak Grzegorz, Stapór-Fudzińska Małgorzata, Głowacki Grzegorz, Tukiendorf Andrzej
Przegl Lek. 2017;74(4):150-6.
This is an update regarding the treatment results of 200 prostate cancer patients’ (PCP) CyberKnife based radioablation (the first group in Poland). The purpose of this study is reevaluation (after 2 years) of this treatment modality results of low (LR) and intermediate risk (IR) (including T2c) PCP and failure analysis.
200 PCP (95 LR, 86 IR, 19 T2c) 53 – 83 y.o. (mean 69) treated between 2011 and 2014. 48% used neoadjuvant ADT. The patients were irradiated every other day with a fraction dose of 7.25 Gy to the total dose 36.25 Gy (5 fractions in 9 days). Fiducials based tracking was performed. The patients were controlled on the treatment completion day, 1, 4, 8 months later and subsequently every 6 months. The PSA concentration, ADT usage, acute and late adverse effects (EORTC/RTOG) and other symptoms were evaluated. FU ranged from 1 to 63.6 months (mean 32.2, median 32.9).
The adverse effects percentage was very low; only 1 month after treatment the percentage of acute urinary reaction exceeded 40%. Only single G3 adverse effects were noted. Over 4 months the median PSA concentration declined from 3.75 to 0.27 ng/ml. 9 failures (4.5%) were noted – more among IR and patients without neoadjuvant ADT. No failure in the T2c group was found. Median time to failure was 32.4 months. Cox analysis revealed that the failure risk increases with the value of maximal PSA before treatment.
CK based radioablation of LR and IR PCP is a safe and highly effective treatment modality. The main prognostic factor of failure after this treatment is probably the maximal PSA concentration before treatment. The neoadjuvant ADT in IR group should be considered. The lack of failures in the T2c group enables us to suggest that even more locally advanced patients (T3) with low PSA and maximal Gleason 3+4 could be treated with this modality.
本文是关于200例前列腺癌患者基于射波刀的放射消融治疗结果的更新（波兰的第一组病例）。本研究的目的是对低危（LR）和中危（IR）（包括T2c）前列腺癌患者这种治疗方式的结果进行重新评估（2年后）并进行失败分析。
200例前列腺癌患者（95例低危，86例中危，19例T₂c期），年龄53 - 83岁（平均69岁），于2011年至2014年接受治疗。48%的患者使用了新辅助雄激素剥夺治疗（ADT）。患者每隔一天接受一次照射，分次剂量为7.25 Gy，总剂量为36.25 Gy（9天内分5次）。采用基于基准点的跟踪技术。在治疗完成日、1个月、4个月、8个月后以及随后每6个月对患者进行复查。评估前列腺特异性抗原（PSA）浓度、ADT使用情况、急性和晚期不良反应（欧洲癌症研究与治疗组织/放射肿瘤学协作组标准）以及其他症状。随访时间为1至63.6个月（平均32.2个月，中位数32.9个月）。
不良反应发生率非常低；仅在治疗后1个月，急性尿路反应发生率超过40%。仅记录到单个3级不良反应。4个多月内，PSA浓度中位数从3.75 ng/ml降至0.27 ng/ml。记录到9例失败病例（4.5%），中危组和未使用新辅助ADT的患者中失败病例更多。T2c组未发现失败病例。失败的中位时间为32.4个月。Cox分析显示，治疗失败风险随治疗前最大PSA值升高而增加。
基于射波刀的低危和中危前列腺癌患者放射消融是一种安全且高效的治疗方式。该治疗后失败的主要预后因素可能是治疗前的最大PSA浓度。中危组应考虑使用新辅助ADT。T2c组未出现失败病例，这使我们建议，对于更多局部进展期（T3）、PSA值低且Gleason评分最高为3 + 4的患者，也可采用这种治疗方式。
