Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.
Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.
Int J Radiat Oncol Biol Phys. 2019 Jul 1;104(3):614-621. doi: 10.1016/j.ijrobp.2019.02.041. Epub 2019 Feb 27.
This study explores the efficacy and safety of reirradiation with modern radiation therapy techniques in patients previously irradiated for prostate cancer and affected by local relapse of disease.
Patients affected by previously irradiated prostate cancer were enrolled in this reirradiation study if they had a biochemical relapse and a C-choline positron emission tomography scan revealing the presence of a local recurrence of disease. Reirradiation consisted of a stereotactic treatment delivered by image guided radiation therapy-volumetric modulated arc therapy with flattening filter-free technology in 5 daily fractions.
Twenty-three patients underwent reirradiation to the prostate, prostatic bed, or prostate and local recurrence. Re-treatment consisted of a median total dose of 25 Gy in 5 fractions. A biochemical response was observed in all cases. Acute toxicity was mainly genitourinary (GU) grade 1 to 2 (n = 13; 56.5%). One patient (4.3%) had grade 3 hematuria. A grade 1 GU late toxicity was registered in 4 patients (17.4%) and grade 3 in 1 patient (4.3%, urethral obstruction). Gastrointestinal toxicity was negligible. Regression analysis showed that only a short elapsed time in months from primary radiation therapy was significantly correlated with acute GU toxicity. After a median follow-up of 33 months (range, 5-58 months), the median biochemical recurrence-free survival was 19 months, and the 2-year biochemical recurrence-free survival (BRFS) was 41.7%. Median local control was 30 months; the 2-year local control rate was 58.1%.
Reirradiation of patients with prostate cancer who underwent previous radiation therapy is a valuable option that can be safely considered to delay the beginning of hormonal treatment.
本研究探讨了在先前因前列腺癌接受过放射治疗且疾病局部复发的患者中，采用现代放射治疗技术进行再放射治疗的疗效和安全性。
患有先前接受过放射治疗的前列腺癌且生化复发、C-胆碱正电子发射断层扫描显示疾病局部复发的患者被纳入本再放射治疗研究。再放射治疗包括使用图像引导放射治疗-容积调制弧形治疗技术进行立体定向治疗，采用无平坦滤过器技术，共 5 个分次。
23 例患者接受了前列腺、前列腺床或前列腺和局部复发的再放射治疗。再治疗包括中位数为 25 Gy 的总剂量，分为 5 个分次。所有病例均观察到生化反应。急性毒性主要为泌尿生殖系统（GU）1 至 2 级（n = 13；56.5%）。1 例（4.3%）患者出现 3 级血尿。4 例（17.4%）患者出现 1 级 GU 迟发性毒性，1 例（4.3%，尿道梗阻）患者出现 3 级毒性。胃肠道毒性可忽略不计。回归分析表明，仅从原发放射治疗开始到现在的时间间隔较短与急性 GU 毒性显著相关。中位随访 33 个月（范围，5-58 个月）后，生化无复发生存的中位时间为 19 个月，2 年生化无复发生存率（BRFS）为 41.7%。局部控制的中位时间为 30 个月；2 年局部控制率为 58.1%。
对先前接受过放射治疗的前列腺癌患者进行再放射治疗是一种有价值的选择，可以安全考虑延迟激素治疗的开始。
