Lee Chia Ching, Lim Keith Hc, Chia David Wt, Chong Yew Lam, Png Keng Siang, Chong Kian Tai, Soon Yu Yang, Tey Jeremy Cs
Department of Radiation Oncology, National University Cancer Institute, Singapore.
Department of Urology, Tan Tock Seng Hospital, Singapore.
Asia Pac J Clin Oncol. 2019 Dec;15(6):323-330. doi: 10.1111/ajco.13197. Epub 2019 Jul 22.
To report outcomes of localized prostate cancer treated with radical external beam radiation therapy (EBRT) in our institution over a 14-year period, and to determine the impact of dose escalation of prostate cancer outcomes.
Patients with T1-T4 N0 M0 prostate cancer who received radical EBRT between January 2002 and December 2015 were reviewed retrospectively. Clinical data were obtained via the institutional electronic medical records. The primary endpoint was 5-year overall survival (OS). The secondary endpoints were 5-year freedom from biochemical failure (FFBF) and treatment toxicities.
A total of 200 eligible patients were identified. Median follow-up duration was 48 months. 13%, 36% and 51% of patients had low-, intermediate- and high-risk disease. Median dose was 79.2 Gy. The 5-year OS were 90%, 87% and 78% and FFBF were 94%, 100% and 81% for low-, intermediate- and high-risk patients, respectively. Multivariable analysis showed that Eastern Cooperate Oncology Group performance status 2 and Gleason grade group 5 were independent predictors of worse OS. The incidence of grade ≥2 proctitis was 24.5%. Dose escalation was significantly associated with increased incidence of grade ≥2 proctitis (odd ratio, 4.42; 95% confidence interval, 1.95-10.08; P < 0.01).
Men with localized prostate cancer treated with EBRT in our population had excellent 5-year OS and biochemical outcomes. Dose escalation did not significantly improve these outcomes but was associated with significantly increased risk of grade ≥2 proctitis in our population. Future studies should be performed to identify patients who will benefit the most from dose-escalated EBRT.
报告我院14年间采用根治性体外放射治疗（EBRT）治疗局限性前列腺癌的结果，并确定剂量递增对前列腺癌治疗结果的影响。
回顾性分析2002年1月至2015年12月期间接受根治性EBRT的T1-T4 N0 M0前列腺癌患者。通过机构电子病历获取临床数据。主要终点为5年总生存率（OS）。次要终点为5年无生化复发（FFBF）和治疗毒性。
共纳入200例符合条件的患者。中位随访时间为48个月。低、中、高危疾病患者分别占13%、36%和51%。中位剂量为79.2 Gy。低、中、高危患者的5年OS分别为90%、87%和78%，FFBF分别为94%、100%和81%。多变量分析显示，东部肿瘤协作组体能状态2级和 Gleason分级5组是OS较差的独立预测因素。≥2级直肠炎的发生率为24.5%。剂量递增与≥2级直肠炎发生率增加显著相关（比值比，4.42；95%置信区间，1.95-10.08；P < 0.01）。
在我们的研究人群中，接受EBRT治疗的局限性前列腺癌男性患者具有良好的5年OS和生化结果。剂量递增并未显著改善这些结果，但在我们的人群中与≥2级直肠炎风险显著增加相关。未来应开展研究，以确定从剂量递增的EBRT中获益最大的患者。
