Department of Radiation Oncology, Tata Memorial Centre and Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, India.
Department of Radiation Oncology, Tata Memorial Centre and Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, India.
Clin Oncol (R Coll Radiol). 2021 Mar;33(3):172-180. doi: 10.1016/j.clon.2020.10.019. Epub 2020 Nov 16.
The safety and efficacy of stereotactic body radiotherapy (SBRT) in localised prostate cancer are now established through phase III randomised trials. Its utility in node-positive prostate cancer is restricted due to a lack of controlled studies specifically addressing this subgroup. Herein we report the safety and efficacy of SBRT in this subgroup.
In total, 60 patients treated with SBRT to prostate and pelvis were analysed. All patients received neoadjuvant androgen deprivation therapy for at least 6 months and long-term adjuvant hormonal therapy (70% medical and 30% surgical). All patients were treated with daily image-guided rotational intensity-modulated radiotherapy. The dose delivered to the prostate and gross node was 35-37.5 Gy and 25 Gy in five fractions to the elective pelvic nodal region on alternate days. Acute and late toxicities were graded as per Radiation Therapy Oncology Group common toxicity criteria.
Forty-one (68%) patients had a Gleason score ≥8. The median prostate-specific antigen level at diagnosis was 39 ng/ml. Twenty (33%) patients had common iliac nodal uptake on initial prostate-specific membrane antigen positron emission tomography-computed tomography. After the median follow-up of 30 months, no acute or late Radiation Therapy Oncology Group grade ≥3 gastrointestinal toxicity was noted. Acute grade 2 genitourinary and gastrointestinal toxicities were 8.3% and 11.7%, respectively. Late grade 2 genitourinary and gastrointestinal toxicities were 3.3% and 8.3%, respectively. Late grade 3 genitourinary toxicity was seen in two (3.3%) patients. Three-year overall survival and biochemical failure-free survival was 89% and 77%, respectively.
SBRT to the prostate and pelvis is safe and efficacious in node-positive prostate cancer even with common iliac nodal involvement (stage M1a).
通过三期随机试验，立体定向体放射治疗（SBRT）治疗局限性前列腺癌的安全性和有效性已得到证实。由于缺乏专门针对该亚组的对照研究，其在淋巴结阳性前列腺癌中的应用受到限制。本文报告了 SBRT 在该亚组中的安全性和疗效。
共分析了 60 例接受 SBRT 治疗前列腺和骨盆的患者。所有患者均接受至少 6 个月的新辅助雄激素剥夺治疗和长期辅助激素治疗（70%为药物治疗，30%为手术治疗）。所有患者均接受每日图像引导旋转强度调制放射治疗。前列腺和大体淋巴结的剂量为 35-37.5Gy 和 25Gy，在 5 天内分 5 次给予选择性盆腔淋巴结区域，隔日一次。急性和晚期毒性按放射治疗肿瘤学组常见毒性标准分级。
41 例（68%）患者的 Gleason 评分≥8。诊断时前列腺特异性抗原水平的中位数为 39ng/ml。20 例（33%）患者在初始前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描时显示髂总淋巴结摄取。中位随访 30 个月后，未见急性或晚期放射治疗肿瘤学组≥3 级胃肠道毒性。急性 2 级泌尿生殖系统和胃肠道毒性分别为 8.3%和 11.7%。晚期 2 级泌尿生殖系统和胃肠道毒性分别为 3.3%和 8.3%。晚期 3 级泌尿生殖系统毒性见于 2 例（3.3%）患者。3 年总生存率和生化无失败生存率分别为 89%和 77%。
即使存在髂总淋巴结受累（M1a 期），SBRT 治疗前列腺和骨盆对淋巴结阳性前列腺癌也是安全有效的。
