de Leon Jeremiah F, Kneebone Andrew, Gebski Val, Cross Shamira, Do Viet, Hayden Amy, Ngo Diana, Sidhom Mark, Turner Sandra
Department of Radiation Oncology, Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia.
Northern Sydney Cancer Centre, Sydney, New South Wales, Australia.
J Med Imaging Radiat Oncol. 2019 Feb;63(1):116-123. doi: 10.1111/1754-9485.12797. Epub 2018 Sep 6.
Optimal definitive treatment of prostate cancer is controversial, especially in high-risk patients. We report the largest prospective cohort of Australian patients treated with radiotherapy for localised prostate cancer.
One thousand, one hundred and twenty-one patients with prostate cancer were prospectively registered and treated to a dose of 70-74 Gy. Patients were classified as low, intermediate or high risk based on PSA, clinical staging and Gleason score. Intermediate-risk patients were treated with 0-6 months of hormonal therapy (ADT) and high-risk patients were offered neoadjuvant and adjuvant ADT. Overall survival (OS) and biochemical relapse-free survival (bNED) were calculated using the Kaplan-Meier method.
Median follow-up was 92 months. Eight-year OS and bNED were 78.4% and 68.1% respectively in the entire cohort. OS for the low, intermediate and high-risk groups was 84.5%, 78.4% and 68% respectively. For these risk groups, bNED was 80.3%, 65.7% and 53.7% respectively. In the intermediate and high-risk group, OS and bNED decreased with increasing number of risk factors.
Definitive radiotherapy is an effective treatment for prostate cancer, including in high-risk cases.
前列腺癌的最佳确定性治疗存在争议，尤其是在高危患者中。我们报告了接受局部前列腺癌放射治疗的澳大利亚患者的最大规模前瞻性队列研究。
前瞻性登记了1121例前列腺癌患者，并给予70 - 74 Gy的剂量治疗。根据前列腺特异性抗原（PSA）、临床分期和 Gleason评分将患者分为低、中、高风险组。中危患者接受0 - 6个月的激素治疗（雄激素剥夺治疗，ADT），高危患者接受新辅助和辅助ADT治疗。采用Kaplan-Meier方法计算总生存期（OS）和生化无复发生存期（bNED）。
中位随访时间为92个月。整个队列的8年总生存率和生化无复发生存率分别为78.4%和68.1%。低、中、高危组的总生存率分别为84.5%、78.4%和68%。对于这些风险组，生化无复发生存率分别为80.3%、65.7%和53.7%。在中危和高危组中，总生存率和生化无复发生存率随着风险因素数量的增加而降低。
确定性放疗是前列腺癌的有效治疗方法，包括高危病例。
