局部前列腺癌患者应用内置式直肠气囊的中度低分割调强放疗的长期疗效。
Long-term outcome of a moderately hypofractionated, intensity-modulated radiotherapy approach using an endorectal balloon for patients with localized prostate cancer.
机构信息
Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center, and Research Institute, Weill Cornell Medical College, 6565 Fannin, Ste#DB1-077, Houston, TX, 77030, USA.
Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA.
出版信息
Cancer Commun (Lond). 2018 Apr 17;38(1):11. doi: 10.1186/s40880-018-0281-4.
BACKGROUND
Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing. However, the optimal radiation fractionation regimen for localized prostate cancer is unclear. Laboratory and clinical evidence suggest that hypofractionation may improve the therapeutic ratio of radiotherapy. We report our institutional outcomes using moderately hypofractionated, intensity-modulated radiotherapy (IMRT), and an endorectal balloon, with emphasis on long-term biochemical control and treatment-related adverse events in patients with localized prostate cancer.
METHODS
Between January 1997 and April 2004, 596 patients with cT1-T3 prostate cancer underwent IMRT using a moderate hypofractionation regimen (76.70 Gy at 2.19 Gy/fraction) with an endorectal balloon. Using D'Amico classification, 226 (37.9%), 264 (44.3%), and 106 (17.8%) patients had low-, intermediate-, or high-risk disease, respectively. The majority of intermediate- and high-risk patients received androgen deprivation therapy. Biochemical relapse-free survival (bRFS) was evaluated using 2005 Phoenix criteria and estimated using the Kaplan-Meier method.
RESULTS
The median follow-up was 62 months. Overall 5- and 10-year bRFS rates were 92.7% and 87.7%. For low-, intermediate-, and high-risk patients, the 5-year bRFS rates were 96.9%, 93.3%, and 82.0%, respectively; the 10-year bRFS rates were 91.4%, 89.3%, and 76.2%, respectively. Prostate-specific antigen, Gleason score, and T stage were significant predictors of bRFS (all P < 0.01). The 5-year rates of severe (≥ Grade 3) adverse events were very low: 1.2% for gastrointestinal events and 1.1% for genitourinary events.
CONCLUSIONS
Long-term outcomes after moderately hypofractionated IMRT are encouraging. Moderate hypofractionation represents a safe, efficacious, alternative regimen in the treatment of localized prostate cancer.
背景
放射治疗技术的进步同时实现了剂量递增和膀胱及直肠的保护。然而，局限性前列腺癌的最佳放疗分割方案仍不明确。实验室和临床证据表明，少分次放疗可能改善放疗的治疗比。我们报告了机构的结果，使用适度少分次、强度调制放疗（IMRT）和直肠内气囊，重点关注局限性前列腺癌患者的长期生化控制和与治疗相关的不良事件。
方法
1997 年 1 月至 2004 年 4 月，596 例 cT1-T3 前列腺癌患者接受了 IMRT 治疗，采用中度少分次方案（76.70Gy，2.19Gy/次）和直肠内气囊。根据 D'Amico 分类，226 例（37.9%）、264 例（44.3%）和 106 例（17.8%）患者分别具有低危、中危和高危疾病。大多数中高危患者接受了雄激素剥夺治疗。采用 2005 年凤凰标准评估生化无复发生存率（bRFS），并采用 Kaplan-Meier 法进行估计。
结果
中位随访时间为 62 个月。总体 5 年和 10 年 bRFS 率分别为 92.7%和 87.7%。低危、中危和高危患者的 5 年 bRFS 率分别为 96.9%、93.3%和 82.0%；10 年 bRFS 率分别为 91.4%、89.3%和 76.2%。前列腺特异性抗原、Gleason 评分和 T 分期是 bRFS 的显著预测因素（均 P<0.01）。5 年严重（≥3 级）不良事件发生率较低：胃肠道事件为 1.2%，泌尿生殖系统事件为 1.1%。
结论
中度少分次 IMRT 后的长期结果令人鼓舞。中度少分次是局限性前列腺癌治疗的一种安全、有效的替代方案。
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