Narang Kushal, Kadian Mohit, Venkatesan K, Mishra Saumyaranjan, Bisht Shyam, Gupta Deepak, Banerjee Susovan, Kataria Tejinder
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurugram, IND.
Cureus. 2020 Nov 28;12(11):e11751. doi: 10.7759/cureus.11751.
Stereotactic body radiation therapy (SBRT) is increasingly being utilized to deliver escalated radiation doses for improving outcomes in various malignancies. We analyzed our cohort of locally advanced, node-positive, and bone oligometastatic prostate cancer patients, that were treated with a combination of pelvic RT using conventional fractionation (CF) and SBRT boost to prostate using extreme hypofractionation (EH), along with hormone therapy (HT).
Outcomes of 44 prospectively treated patients were analyzed. Volumetric modulated arc therapy (VMAT) was utilized to deliver a dose of 45 Gy to pelvic nodal region, 50 Gy to prostate, and 54-56 Gy to gross nodes in 25 fractions. EH boost 18 Gy in three fractions was delivered to the prostate using CyberKnife (Accuray, Sunnyvale, CA, USA) SBRT. Bone oligometastasis, if any, were treated to a dose of 16 Gy in two fractions, delivered on weekends. Serum prostate-specific antigen (PSA), multi-parametric magnetic resonance imaging (MRI) of pelvis, and prostate-specific membrane antigen-positron emission tomography (PSMA-PET) were used for response assessment during follow-up. HT was given as per standard guidelines.
There were 33 (75%) locally advanced, nine (20.5%) node-positive, and two (4.5%) oligometastatic cases. At a median follow-up of 63.5 months, the five-year progression-free survival (PFS) was 88.2%, biochemical PFS (bPFS) was 91.4% and overall survival (OS) was 96.9%. Grade III or greater acute genitourinary and gastrointestinal toxicity was 2.3% each, and late toxicity was 4.5% and 0%, respectively.
Excellent five-year outcomes can be attained even for locally advanced, node-positive and bone oligometastatic prostate cancer, by means of dose-escalation using EH-SBRT boost to the prostate.
立体定向体部放射治疗（SBRT）越来越多地被用于提高放射剂量，以改善各种恶性肿瘤的治疗效果。我们分析了一组局部晚期、淋巴结阳性和骨寡转移的前列腺癌患者，这些患者接受了传统分割（CF）盆腔放疗联合使用极短分割（EH）SBRT对前列腺进行加量放疗，以及激素治疗（HT）。
分析了44例接受前瞻性治疗患者的结果。采用容积调强弧形放疗（VMAT），25次分割，向盆腔淋巴结区域给予45 Gy剂量，向前列腺给予50 Gy剂量，向肿大淋巴结给予54 - 56 Gy剂量。使用射波刀（Accuray，美国加利福尼亚州桑尼维尔）SBRT向前列腺给予3次分割共18 Gy的EH加量放疗。如有骨寡转移，在周末给予2次分割共16 Gy的剂量。随访期间，使用血清前列腺特异性抗原（PSA）、盆腔多参数磁共振成像（MRI）和前列腺特异性膜抗原正电子发射断层扫描（PSMA - PET）进行疗效评估。HT按照标准指南给予。
有33例（75%）局部晚期、9例（20.5%）淋巴结阳性和2例（4.5%）寡转移病例。中位随访63.5个月时，五年无进展生存率（PFS）为88.2%，生化无进展生存率（bPFS）为91.4%，总生存率（OS）为96.9%。III级或更高级别的急性泌尿生殖系统和胃肠道毒性分别为2.3%，晚期毒性分别为4.5%和0%。
对于局部晚期、淋巴结阳性和骨寡转移的前列腺癌，通过使用EH - SBRT对前列腺进行加量放疗来提高剂量，即使是五年的治疗效果也很好。
