Mai Lixin, Zhang Zitong, Li Yonghong, Liu Ruiqi, Li Jibin, Huang Sijuan, Lin Maosheng, Liu Boji, Cao Wufei, Wu Jianhua, Liu Mengzhong, Zhou Fangjian, Liu Yang, He Liru
Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Front Oncol. 2020 Dec 4;10:606133. doi: 10.3389/fonc.2020.606133. eCollection 2020.
The role of local radiotherapy in metastatic castration-resistant prostate cancer (mCRPC) remains undefined. This study aimed to identify the value of local radiotherapy and potential candidates for mCRPC.
A total of 215 patients with mCRPC treated with or without cytoreductive radiotherapy (CRT) between June 2011 and February 2019 were analyzed. Overall survival (OS) was calculated from the onset of mCRPC. The receiver-operating characteristic (ROC) curve was used to find the cutoff point for time to castration resistance (TCR).
One-hundred and fifty-five (72.1%) patients received abiraterone after mCRPC, and 54 (25.1%) patients received CRT. The median TCR was 14.9 months. After a median follow-up of 31.7 months, the median OS was 33.3 months. The Eastern Cooperative Oncology Group (ECOG) performance scores 0-1, oligometastases, abiraterone after mCRPC, CRT, and TCR ≥9 months were independent prognostic factors for better OS. Stratified analyses showed improved survival when CRT was applied to patients treated with abiraterone (HR 0.44; 95% CI 0.23-0.83; P = 0.012) and TCR ≥9 months (HR 0.39; 95% CI 0.21-0.74; P = 0.004). The percentage of PSA response after radiotherapy was higher in patients with TCR ≥9 months compared to those with TCR <9 months. No grade 3 or worse adverse events after radiotherapy were reported.
ECOG performance score, oligometastases, abiraterone application, TCR and CRT were independent prognostic factors for OS in patients with mCRPC. Patients with a short duration of response to primary androgen deprivation therapy were less likely to benefit from CRT.
局部放疗在转移性去势抵抗性前列腺癌（mCRPC）中的作用仍不明确。本研究旨在确定局部放疗的价值以及mCRPC的潜在候选因素。
分析了2011年6月至2019年2月期间共215例接受或未接受减瘤放疗（CRT）的mCRPC患者。总生存期（OS）从mCRPC发病时开始计算。采用受试者操作特征（ROC）曲线来确定去势抵抗时间（TCR）的截断点。
155例（72.1%）患者在mCRPC后接受了阿比特龙治疗，54例（25.1%）患者接受了CRT。中位TCR为14.9个月。中位随访31.7个月后，中位OS为33.3个月。东部肿瘤协作组（ECOG）体能状态评分为0 - 1、寡转移、mCRPC后使用阿比特龙、CRT以及TCR≥9个月是OS较好的独立预后因素。分层分析显示，当对接受阿比特龙治疗的患者（HR 0.44；95%CI 0.23 - 0.83；P = 0.012）和TCR≥9个月的患者（HR 0.39；95%CI 0.21 - 0.74；P = 0.004）应用CRT时，生存期得到改善。与TCR < 9个月的患者相比，TCR≥9个月的患者放疗后PSA反应率更高。放疗后未报告3级或更严重的不良事件。
ECOG体能状态评分、寡转移、阿比特龙应用、TCR和CRT是mCRPC患者OS的独立预后因素。对初始雄激素剥夺治疗反应持续时间短的患者从CRT中获益的可能性较小。
