Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China.
Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100006, China.
Radiat Oncol. 2020 Oct 2;15(1):231. doi: 10.1186/s13014-020-01679-0.
There is an increasing application of moderately hypofractionated radiotherapy for prostate cancer. We presented our outcomes and treatment-related toxicities with moderately hypofractionated (67.5 Gy in 25 fractions) radiotherapy for a group of advanced prostate cancer patients from China.
From November 2006 to December 2018, 246 consecutive patients with prostate cancer confined to the pelvis were treated with moderately hypofractionated radiotherapy (67.5 Gy in 25 fractions). 97.6% of the patients received a different duration of androgen deprivation therapy. Failure-free survival (FFS), prostate cancer-specific survival (PCSS), overall survival (OS), and cumulative grade ≥ 2 late toxicity were evaluated using the Kaplan-Meier actuarial method. Prognostic factors for FFS, PCSS, and OS were analyzed.
The median follow-up time was 74 months (range: 6-150 months). For all patients, the 5- and 10-year FFS rates were 80.0% (95% CI: 74.7-85.7%) and 63.5% (95% CI 55.4-72.8%). The failure rates for the intermediate, high-risk, locally advanced, and N1 groups were 6.1%, 13.0%, 18.4%, and 35.7%, respectively (P = 0.003). Overall, 5- and 10-year PCSS rates were 95.7% (95% CI 93.0-98.5%) and 88.2% (95% CI 82.8-93.8%). Prostate cancer-specific mortality rates for the high-risk, locally advanced, and N1 groups were 4.0%, 8.2%, and 23.8%, respectively (P < 0.001). Overall, 5- and 10-year actuarial OS rates were 92.4% (95% CI 88.8-96.1%) and 72.7% (95% CI 64.8-81.5%). High level prostate-specific antigen and positive N stage were significantly associated with worse FFS (P < 0.05). Advanced T stage and positive N stage emerged as worse predictors of PCSS (P < 0.05). Advanced age, T stage, and positive N stage were the only factors that were significantly associated with worse OS (P < 0.05). The 5-year cumulative incidence rate of grade ≥ 2 late GU and GI toxicity was 17.8% (95% CI 12.5-22.7%) and 23.4% (95% CI 17.7-28.7%), respectively.
Moderately hypofractionated radiotherapy (67.5 Gy in 25 fractions) for this predominantly high-risk, locally advanced, or N1 in Chinese patients demonstrates encouraging long-term outcomes and acceptable toxicity. This fractionation schedule deserves further evaluation in similar populations.
越来越多的前列腺癌患者接受中度亚分割放射治疗。我们报告了一组来自中国的晚期前列腺癌患者接受中度亚分割（67.5 Gy/25 次）放射治疗的结果和与治疗相关的毒性。
从 2006 年 11 月至 2018 年 12 月，246 例局限于骨盆的前列腺癌患者接受了中度亚分割放疗（67.5 Gy/25 次）。97.6%的患者接受了不同持续时间的雄激素剥夺治疗。采用 Kaplan-Meier 生存分析法评估无失败生存率（FFS）、前列腺癌特异性生存率（PCSS）、总生存率（OS）和累积≥2 级晚期毒性。分析了 FFS、PCSS 和 OS 的预后因素。
中位随访时间为 74 个月（范围：6-150 个月）。所有患者的 5 年和 10 年 FFS 率分别为 80.0%（95%CI：74.7-85.7%）和 63.5%（95%CI 55.4-72.8%）。中危、高危、局部晚期和 N1 组的失败率分别为 6.1%、13.0%、18.4%和 35.7%（P=0.003）。总体而言，5 年和 10 年的 PCSS 率分别为 95.7%（95%CI：93.0-98.5%）和 88.2%（95%CI：82.8-93.8%）。高危、局部晚期和 N1 组的前列腺癌特异性死亡率分别为 4.0%、8.2%和 23.8%（P<0.001）。总体而言，5 年和 10 年的 OS 生存率分别为 92.4%（95%CI：88.8-96.1%）和 72.7%（95%CI：64.8-81.5%）。高 PSA 水平和阳性 N 期与较差的 FFS 显著相关（P<0.05）。高级 T 期和阳性 N 期是 PCSS 较差的预测因素（P<0.05）。高龄、T 期和阳性 N 期是与 OS 显著相关的唯一因素（P<0.05）。5 年累积≥2 级晚期 GU 和 GI 毒性发生率分别为 17.8%（95%CI：12.5-22.7%）和 23.4%（95%CI：17.7-28.7%）。
对于主要为高危、局部晚期或 N1 的中国患者，中度亚分割放疗（67.5 Gy/25 次）显示出令人鼓舞的长期结果和可接受的毒性。这种分割方案值得在类似人群中进一步评估。
