Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Med Oncol. 2018 Nov 27;36(1):9. doi: 10.1007/s12032-018-1233-1.
To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69-77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.
报告在一系列接受前列腺癌 (PCa) 治疗的患者中，中度亚分割图像引导外照射放疗的毒性和疗效结果。在 2006 年 10 月至 2015 年 12 月期间，572 名 T1-T3N0M0 PCa 患者接受了 70.2Gy 的 26 次分割治疗，每次 2.7Gy：344 名患者（60%）接受了三维适形放疗 (3D-CRT)，228 名患者（40%）接受了调强放疗 (IMRT)。分别使用放射治疗肿瘤学组/欧洲癌症研究与治疗组织标准和休斯顿定义（最低值+2）来评估毒性和生化失败。中位年龄为 74 岁（四分位距 69-77）。与 3D-CRT 相比，在 IMRT 组中，更多的高危患者（29%对 18%；P=0.002）和更大的靶区体积（75%对 60%；P<0.001）被纳入。IMRT 和 3D-CRT 患者的急性胃肠 (GI) 毒性 G>1 分别为 8%和 11%，而晚期 GI G>1 分别为 2%和 16%。IMRT 和 3D-CRT 患者的急性泌尿生殖 (GU) 毒性 G>1 分别为 26%和 40%，而晚期 GU G>1 分别为 5%和 15%。多因素比例风险 Cox 模型证实，与 IMRT 相比，3D-CRT 发生晚期 GU 毒性 (P=0.004) 和 GI 毒性 (P<0.001) 的风险显著增加。在中位 4 年随访中，整个系列的总生存 (OS)、临床无进展生存 (cPFS) 和生化无进展生存 (bPFS) 分别为 91%、92%和 91%。cPFS 和 bPFS 根据风险组明显不同。bPFS 和 cPFS 的多因素 Cox 模型显示放疗技术之间无差异，而风险组和初始 PSA 有显著影响。中度亚分割放疗是局限性前列腺癌的可行治疗选择，具有良好的肿瘤控制和满意的毒性谱。IMRT 似乎与毒性降低有关，而肿瘤控制在 IMRT 和 3D-CRT 患者之间是相等的，主要取决于风险类别。
