Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain.
Department of Medical Physics, HM Hospitales, Madrid, Spain.
Clin Transl Oncol. 2021 Jul;23(7):1452-1462. doi: 10.1007/s12094-020-02543-z. Epub 2021 Jan 12.
Conventional post-prostatectomy radiation therapy comprises 6.5-8 weeks of treatment, therefore, hypofractionated and shortened schemes arouse increasing interest. We describe our experience regarding feasibility and clinical outcome of a post-prostatectomy moderate hypofractionated image-guided radiotherapy schedule MATERIALS AND METHODS: From Oct 2015-Mar 2020, 113 patients, median age of 62 years-old (range 45-76) and prostate adenocarcinoma of low risk (30%), intermediate risk (49%) and high risk (21%) were included for adjuvant (34%) or salvage radiation therapy (66%) after radical prostatectomy (RP). All patients underwent radiotherapy with image-guided IMRT/VMAT to a total dose of 62.5 Gy in 2.5 Gy/fraction in 25 fractions. Sixteen patients (14%) received concomitant androgen deprivation therapy.
With a median follow-up of 29 months (range 3-60 months) all patients but three are alive. Eleven patients (10%) developed exclusive biochemical relapse while 19 patients (17%) presented macroscopically visible relapse: prostatectomy bed in two patients (2%), pelvic lymph nodes in 13 patients (11.5%) and distant metastases in four patients (4%). The 3 years actuarial rates for OS, bFRS, and DMFS were 99.1, 91.1 and 91.2%, respectively. Acute and late tolerance was satisfactory. Maximal acute genitourinary (AGU) toxicity was G2 in 8% of patients; maximal acute gastrointestinal (AGI) toxicity was G2 in 3.5% of patients; maximal late genitourinary (LGU) toxicity was G3 in 1% of patients and maximal late gastrointestinal (LGI) toxicity was G2 in 2% of patients. There were no cases of severe acute or late toxicity. No relationship was found between acute or late GI/GU adverse effects and dosimetric parameters, age, presence of comorbidities or concomitant treatments.
Hypofractionated radiotherapy (62.5 Gy in 25 2.5 Gy fractions) is feasible and well tolerated with low complication rates allowing for a moderate dose-escalation that offers encouraging clinical results for biochemical control and survival in patients with prostate cancer after radical prostatectomy.
传统的前列腺癌根治术后放射治疗包括 6.5-8 周的治疗，因此，缩短和分段治疗方案引起了越来越多的关注。我们描述了我们在前列腺癌根治术后中度分割图像引导放疗方案的可行性和临床结果方面的经验。
从 2015 年 10 月至 2020 年 3 月，共纳入 113 例前列腺腺癌患者，中位年龄 62 岁（范围 45-76 岁），低危（30%）、中危（49%）和高危（21%）。所有患者均接受图像引导调强放疗/VMAT 治疗，总剂量为 62.5Gy，2.5Gy/分次，共 25 次。16 例（14%）患者接受同期雄激素剥夺治疗。
中位随访时间为 29 个月（范围 3-60 个月），除 3 例患者外，所有患者均存活。11 例（10%）患者仅发生生化复发，19 例（17%）患者出现肉眼可见的复发：2 例（2%）患者为前列腺床复发，13 例（11.5%）患者为盆腔淋巴结复发，4 例（4%）患者为远处转移。3 年的总生存率（OS）、生化无复发生存率（bFRS）和无远处转移生存率（DMFS）分别为 99.1%、91.1%和 91.2%。急性和晚期的耐受性良好。最大急性泌尿生殖系统（AGU）毒性为 2 级，占 8%；最大急性胃肠道（AGI）毒性为 2 级，占 3.5%；最大晚期泌尿生殖系统（LGU）毒性为 1 级，占 1%；最大晚期胃肠道（LGI）毒性为 2 级，占 2%。没有严重的急性或晚期毒性。急性或晚期胃肠道/泌尿生殖系统不良反应与剂量学参数、年龄、合并症或同时治疗无相关性。
低分割放疗（62.5Gy，25 次，2.5Gy/次）是可行的，耐受性良好，并发症发生率低，可以适度增加剂量，为前列腺癌根治术后患者提供有希望的生化控制和生存的临床结果。
