Kharod Shivam M, Mercado Catherine E, Morris Christopher G, Bryant Curtis M, Mendenhall Nancy P, Mendenhall William M, Nichols R Charles, Hoppe Bradford S, Liang Xiaoying, Su Zhong, Li Zuofeng, Henderson Randal H
Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA.
Department of Radiation Oncology, Orlando Health, Orlando, FL, USA.
Int J Part Ther. 2021 Mar 12;7(4):52-64. doi: 10.14338/IJPT-20-00021.1. eCollection 2021 Spring.
Postprostatectomy radiation improves disease control, but limited data exist regarding outcomes, toxicities, and patient-reported quality of life with proton therapy.
The first 102 patients who were enrolled on an outcome tracking protocol between 2006 and 2017 and treated with double-scattered proton therapy after prostatectomy were retrospectively reviewed. Eleven (11%) received adjuvant radiation, while 91 (89%) received salvage radiation. Seventy-four received double-scattered proton therapy to the prostate bed only. Twenty-eight received a double-scattered proton therapy prostate-bed boost after prostate-bed and pelvic-node treatment. Eleven adjuvant patients received a median dose of 66.6 GyRBE (range, 66.0-70.2). Ninety-one salvage patients received a median dose of 70.2 GyRBE (range, 66.0-78.0). Forty-five patients received androgen deprivation therapy for a median 9 months (range, 1-30). Toxicities were scored using Common Terminology Criteria for Adverse Events v4.0 criteria, and patient-reported quality-of-life data were reviewed.
The median follow-up was 5.5 years (range, 0.8-11.4 years). Five-year biochemical relapse-free and distant metastases-free survival rates were 72% and 91% for adjuvant patients, 57% and 97% for salvage patients, and 57% and 97% overall. Acute and late grade 3 or higher genitourinary toxicity rates were 1% and 7%. No patients had grade 3 or higher gastrointestinal toxicity. Acute and late grade 2 gastrointestinal toxicities were 5% and 2%. The mean values and SDs of the International Prostate Symptom Score, International Index of Erectile Function, and Expanded Prostate Cancer Index Composite bowel function and bother were 7.5 (SD = 5.9), 10.2 (SD = 8.3), 92.8 (SD = 11.1), and 91.2 (SD = 6.4), respectively, at baseline, and 12.1 (SD = 9.1), 10.1 (SD = 6.7), 87.3 (SD = 18), and 86.7 (SD = 13.8) at the 5-year follow-up.
High-dose postprostatectomy proton therapy provides effective long-term biochemical control and freedom from metastasis, with low acute and long-term gastrointestinal and genitourinary toxicity.
前列腺切除术后放疗可改善疾病控制情况，但关于质子治疗的疗效、毒性以及患者报告的生活质量方面的数据有限。
回顾性分析了2006年至2017年间纳入一项结果跟踪方案并在前列腺切除术后接受双散射质子治疗的前102例患者。11例（11%）接受辅助放疗，91例（89%）接受挽救性放疗。74例仅接受前列腺床的双散射质子治疗。28例在前列腺床和盆腔淋巴结治疗后接受双散射质子治疗前列腺床加量照射。11例辅助放疗患者接受的中位剂量为66.6 GyRBE（范围66.0 - 70.2）。91例挽救性放疗患者接受的中位剂量为70.2 GyRBE（范围66.0 - 78.0）。45例患者接受了中位时间为9个月（范围1 - 30个月）的雄激素剥夺治疗。使用不良事件通用术语标准v4.0对毒性进行评分，并对患者报告的生活质量数据进行了评估。
中位随访时间为5.5年（范围0.8 - 11.4年）。辅助放疗患者的5年无生化复发和无远处转移生存率分别为72%和91%，挽救性放疗患者分别为57%和97%，总体分别为57%和97%。急性和晚期3级或更高等级的泌尿生殖系统毒性发生率分别为1%和7%。无患者发生3级或更高等级的胃肠道毒性。急性和晚期2级胃肠道毒性发生率分别为5%和
