Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
Clin Oncol (R Coll Radiol). 2019 Apr;31(4):260-264. doi: 10.1016/j.clon.2019.01.004. Epub 2019 Feb 2.
Node-positive prostate cancer is a unique subgroup, with varied practice on locoregional treatment. Definitive treatment with hypofractionated radiotherapy has not been widely reported. We have routinely used standard regimens of hypofractionated radiotherapy for node-positive disease and report our results of toxicity, biochemical control and survival.
Medical records of patients diagnosed with prostate cancer between February 2011 and April 2016 with radiologically involved pelvic nodes on magnetic resonance imaging/computed tomography without distant metastases were analysed. All patients were treated with long-term androgen deprivation therapy (ADT) and hypofractionated radiotherapy. Acute and late toxicities were assessed using Radiation Therapy Oncology Group acute and late morbidity scoring criteria. Biochemical control and survival were computed using Kaplan-Meier survival statistics.
In total, 61 patients were identified with node-positive disease, with a median age of 68 years and a median initial prostate-specific antigen level of 40.1 ng/ml. Most, 50 (81.9%), had T3 disease; 47.6% had Gleason 8-10 disease. All were treated with hypofractionated intensity-modulated radiotherapy, predominantly 60 Gy/20 fractions/4 weeks, with a dose of 44 Gy/20 fractions to the pelvic nodes. Twenty-five patients (41%) who had residual radiologically enlarged nodes after 3-6 months of ADT received nodal boost to the involved nodes, to a dose of 54-60 Gy as simultaneous boost. Incidences of late grade 2 + gastrointestinal and genitourinary toxicities were 13.1 and 18%, respectively, with no grade 4 toxicities. With a median follow-up of 48 months, 15 (24.6%) patients developed biochemical failure, with only four locoregional failures. The 4-year biochemical control rate was 77.5% and overall survival was 91%. Patients who had residual enlarged nodes after initial ADT had worse biochemical control (53.9% versus 93.1% at 4 years, P < 0.001).
Moderately hypofractionated radiotherapy using an established fractionation schedule with long-term ADT for node-positive prostate cancer patients is feasible and results in excellent biochemical control rates at 4 years, with acceptable late toxicity rates. The response to initial ADT predicts outcomes.
阳性淋巴结前列腺癌是一个独特的亚组，局部区域治疗的方法多种多样。采用分割剂量的短程放疗进行确定性治疗尚未得到广泛报道。我们常规使用标准的短程分割放疗方案治疗阳性淋巴结前列腺癌，并报告我们的毒性、生化控制和生存结果。
分析了 2011 年 2 月至 2016 年 4 月期间，磁共振成像/计算机断层扫描显示盆腔淋巴结有放射学受累且无远处转移的前列腺癌患者的病历资料。所有患者均接受长期雄激素剥夺治疗（ADT）和短程分割放疗。采用放射治疗肿瘤学组急性和晚期并发症评分标准评估急性和晚期毒性。使用 Kaplan-Meier 生存统计计算生化控制和生存。
共确定了 61 例阳性淋巴结疾病患者，中位年龄为 68 岁，中位初始前列腺特异性抗原水平为 40.1ng/ml。大多数（50 例，81.9%）为 T3 期疾病；47.6%为 Gleason 8-10 级疾病。所有患者均接受短程分割调强放疗治疗，主要为 60 Gy/20 次/4 周，盆腔淋巴结剂量为 44 Gy/20 次。25 例（41%）患者在 ADT 治疗 3-6 个月后，残留影像学上增大的淋巴结，给予受累淋巴结同步推量，剂量为 54-60 Gy。晚期 2+级胃肠道和泌尿生殖系统毒性的发生率分别为 13.1%和 18%，无 4 级毒性。中位随访 48 个月时，15 例（24.6%）患者发生生化失败，仅有 4 例局部区域复发。4 年生化控制率为 77.5%，总生存率为 91%。初始 ADT 后残留增大淋巴结的患者生化控制较差（4 年时分别为 53.9%和 93.1%，P<0.001）。
采用既定分割方案的中度短程放疗联合长期 ADT 治疗阳性淋巴结前列腺癌患者是可行的，4 年时生化控制率非常高，晚期毒性发生率可接受。初始 ADT 的反应可预测结局。
