Department of Radiation Oncology, E-Da Hospital, Kaohsiung, Taiwan.
Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
Br J Radiol. 2021 May 1;94(1121):20200456. doi: 10.1259/bjr.20200456. Epub 2021 Apr 16.
Image-guided radiotherapy (IGRT) is a recommended advanced radiation technique that is associated with fewer acute and chronic toxicities. However, one Phase III trial showed worse overall survival in the IGRT arm. The purpose of this observational study is to evaluate the impact of IGRT on overall survival.
We used the Taiwan Cancer Registry Database to enroll cT1-4N0M0 prostate cancer patients who received definitive radiotherapy between 2011 and 2015. We used inverse probability treatment weighting (IPW) to construct balanced IGRT and non-IGRT groups. We compared the overall survival of those in the IGRT and non-IGRT groups. Supplementary analyses (SA) were performed with alternative covariates in propensity score (PS) models and PS approaches. The incidence rates of prostate cancer mortality (IPCM), other cancer mortality (IOCM), and cardiovascular mortality (ICVM) were also evaluated.
There were 360 patients in the IGRT arm and 476 patients in the non-IGRT arm. The median follow-up time was 50 months. The 5-year overall survival was 88% in the IGRT arm and 86% in the non-IGRT arm (adjusted hazard ratio [HR] of death = 0.93; 95% CI, 0.61-1.45; = 0.77). The SA also showed no significant differences in the overall survival between those in the IGRT and non-IGRT arms. Both groups did not significantly differ in terms of IPCM, IOCM, and ICVM.
The overall survival of localized prostate cancer patients who underwent IGRT was not inferior to those who did not.
We demonstrated that the overall survival for prostate cancer patients with IGRT was not worse than those who did not undergo IGRT; this important outcome comparison has not been previously examined in the general population.
图像引导放疗（IGRT）是一种推荐的先进放疗技术，与较少的急性和慢性毒性相关。然而，一项三期试验显示 IGRT 组的总生存率较差。本观察性研究的目的是评估 IGRT 对总生存率的影响。
我们使用台湾癌症登记数据库招募了 2011 年至 2015 年间接受根治性放疗的 cT1-4N0M0 前列腺癌患者。我们使用逆概率治疗加权（IPW）来构建平衡的 IGRT 和非 IGRT 组。我们比较了 IGRT 组和非 IGRT 组的总生存率。在倾向评分（PS）模型和 PS 方法中，使用替代协变量进行补充分析（SA）。还评估了前列腺癌死亡率（ICPM）、其他癌症死亡率（IOCM）和心血管死亡率（ICVM）的发生率。
IGRT 组有 360 例患者，非 IGRT 组有 476 例患者。中位随访时间为 50 个月。IGRT 组的 5 年总生存率为 88%，非 IGRT 组为 86%（调整死亡风险比 [HR] = 0.93；95%CI，0.61-1.45；= 0.77）。SA 也显示 IGRT 组和非 IGRT 组之间的总生存率无显著差异。两组在 ICPM、IOCM 和 ICVM 方面也无显著差异。
接受 IGRT 的局限性前列腺癌患者的总生存率并不低于未接受 IGRT 的患者。
我们证明，接受 IGRT 的前列腺癌患者的总生存率并不比未接受 IGRT 的患者差；这一重要的结果比较以前在一般人群中没有被检查过。
