Miszczyk Leszek, Stąpór-Fudzińska Małgorzata, Miszczyk Marcin, Maciejewski Bogusław, Tukiendorf Andrzej
1 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
2 Treatment Planning Department, Gliwice, Poland.
Technol Cancer Res Treat. 2018 Jan 1;17:1533033818785496. doi: 10.1177/1533033818785496.
The aim of this study was to evaluate CyberKnife-based radioablation as a salvage treatment for prostate cancer postirradiation relapses based on a group of patients disqualified from available conventional methods of salvage treatment. Thirty-eight patients were treated with a fraction dose varying from 5.5 to 10 Gy (median 7.35) to a total dose of 18 to 36.25 Gy (median 36.25). In all, 55.3% of patients had androgen deprivation therapy during this time. Nine patients had oligometastases in the salvage time. The follow-up varied from 1.6 to 46.4 months (mean 19.7, median 14.4). In all, 92.6% to 97.4% of patients had no gastrointestinal acute adverse effects; no effects higher than G1 were noted. There were particular (up to 4.8%) G2 late gastrointestinal effects. The percentage without genitourinary acute effects varied from 59.1% to 78.9%; 3.7% had G3 toxicity. G3 late genitourinary toxicity appeared 3 times, the maximal percentage being 12.5% (24 months after salvage treatment). The nadir of prostate-specific antigen median was 0.24 ng/mL (9 months after treatment). Twelve (31.6%) patients failed in the timeline of 6 to 42 months after salvage treatment (mean 18.7, median 16.5)-5 due to dissemination. In 2 cases, progression in existing metastases was identified. Five (13.2%) patients had biochemical failure without additional metastases (local relapses); hence, local control was 86.8%. The failure risk is strongly influenced by initial disease stage and presalvage prostate-specific antigen concentration. The obtained results permit us to conclude that such a treatment could be an effective and safe option for prostate cancer postirradiation relapse salvage treatment.
本研究的目的是基于一组不符合现有传统挽救治疗方法条件的患者，评估基于射波刀的放射性消融作为前列腺癌放疗后复发的挽救治疗方法。38例患者接受了分次剂量为5.5至10 Gy（中位数7.35）、总剂量为18至36.25 Gy（中位数36.25）的治疗。在此期间，共有55.3%的患者接受了雄激素剥夺治疗。9例患者在挽救治疗时出现寡转移。随访时间从1.6至46.4个月不等（平均19.7个月，中位数14.4个月）。总体而言，92.6%至97.4%的患者无胃肠道急性不良反应；未观察到高于1级的反应。有特定的（高达4.8%）2级晚期胃肠道反应。无泌尿生殖系统急性反应的百分比在59.1%至78.9%之间；3.7%的患者出现3级毒性。3级晚期泌尿生殖系统毒性出现3次，最大百分比为12.5%（挽救治疗后24个月）。前列腺特异性抗原中位数的最低点为0.24 ng/mL（治疗后9个月）。12例（31.6%）患者在挽救治疗后6至42个月（平均18.7个月，中位数16.5个月）出现失败——5例因播散。在2例患者中，发现现有转移灶进展。5例（13.2%）患者出现生化失败但无额外转移（局部复发）；因此，局部控制率为86.8%。失败风险受初始疾病阶段和挽救前前列腺特异性抗原浓度的强烈影响。获得的结果使我们能够得出结论，这种治疗可能是前列腺癌放疗后复发挽救治疗的一种有效且安全的选择。
