Department of Radiation Oncology, McGill University, Quebec, Canada.
Department of Medical Physics, McGill University, Quebec, Canada.
Pract Radiat Oncol. 2020 Nov-Dec;10(6):e514-e520. doi: 10.1016/j.prro.2020.06.012. Epub 2020 Jul 29.
Moderate hypofractionated radiation therapy (HypoRT) is an attractive alternative to conventionally fractionated radiation therapy for prostate cancer. However, most studies using HypoRT only included the prostate as the target volume. We report long-term outcomes of patients with high-risk prostate cancer treated with androgen deprivation therapy (ADT) and HypoRT to the prostate and nodal areas with a simultaneous integrated boost technique.
Patients with localized, high-risk prostate cancer entered a prospective phase I/II study with a HypoRT regimen of 60 Gy/20 fractions (4 weeks) to the prostate volume while the nodal areas received 44 Gy in the same 20 fractions delivered with intensity modulated radiation therapy with a simultaneous integrated boost technique. ADT started 2 to 3 months before HypoRT. Toxicity was prospectively assessed according to the Common Terminology Criteria for Adverse Events v3. Outcomes rates were calculated by the actuarial method of Kaplan-Meier from the date of last radiation treatment until date of event.
We report on the first 105 patients treated between October 2010 and February 2014. Median follow-up was 74 months, with 97% of patients followed for more than 36 months. Median ADT duration was 18 months. The worst grade 2 or higher late gastrointestinal or genitourinary toxicity was seen in 7% and 9%, respectively. There was no grade 4 or 5 toxicity. At the last follow-up, the rates of grade ≥2 gastrointestinal or genitourinary toxicity were 2% and 3%, respectively, with no residual grade ≥3 toxicity. The 5- and 7-year actuarial overall survival and relapse free survival were 91% and 85% and 87% and 81%, respectively.
The longest follow-up report of moderate HypoRT (plus ADT) to the prostate and pelvic nodes shows that this approach is feasible, well tolerated, and effective. It is convenient for patients and the health system. A larger randomized trial using this approach is warranted.
中度适形放疗（HypoRT）是前列腺癌常规分割放疗的一种有吸引力的替代方法。然而，大多数使用 HypoRT 的研究仅将前列腺作为靶区。我们报告了采用雄激素剥夺治疗（ADT）和 HypoRT 对前列腺和淋巴结区域进行同步综合boost 技术治疗高危前列腺癌患者的长期结果。
患有局限性高危前列腺癌的患者入组了一项前瞻性 I/II 期研究，采用 HypoRT 方案，前列腺体积给予 60 Gy/20 次（4 周），同时采用调强放疗给予同步综合 boost 技术，淋巴结区域给予 44 Gy/20 次。ADT 在 HypoRT 前 2-3 个月开始。毒性按照不良事件通用术语标准 v3 进行前瞻性评估。生存结局通过 Kaplan-Meier actuarial 方法从最后一次放疗日期计算至事件日期。
我们报告了 2010 年 10 月至 2014 年 2 月期间治疗的前 105 例患者。中位随访时间为 74 个月，97%的患者随访时间超过 36 个月。中位 ADT 持续时间为 18 个月。最严重的 2 级或更高级别的晚期胃肠道或泌尿生殖系统毒性分别为 7%和 9%。没有 4 级或 5 级毒性。最后一次随访时，2 级或以上胃肠道或泌尿生殖系统毒性发生率分别为 2%和 3%，无残留 3 级以上毒性。5 年和 7 年的总生存率和无复发生存率分别为 91%和 85%和 87%和 81%。
中度 HypoRT（加 ADT）治疗前列腺和骨盆淋巴结的最长随访报告表明，这种方法是可行的，耐受性良好，并且有效。对患者和医疗系统都很方便。需要更大规模的随机试验来验证这种方法。
