Liveringhouse Casey, Sim Austin, Yamoah Kosj, Poch Michael, Wilder Richard B, Pow-Sang Julio, Johnstone Peter A S
Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, United States.
Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, United States.
Rep Pract Oncol Radiother. 2021 Apr 14;26(2):188-195. doi: 10.5603/RPOR.a2021.0027. eCollection 2021.
The aim of the study was to investigate the safety of combining preoperative stereotactic body radiotherapy (SBRT) with robotic radical prostatectomy (RP) for high risk prostate cancer (HRCaP). Many patients with HRCaP will require adjuvant or salvage radiotherapy after RP. The addition of preoperative SBRT before RP may spare patients from subsequent prolonged courses of RT.
Eligible patients had NCC N HRCaP and received a total of 25 Gy or 30 Gy in five daily fractions of SBRT to the prostate and seminal vesicles followed by robotic RP with pelvic lymphadenectomy 31-45 days later. The primary endpoint was prevalence of acute genitourinary (GU) and gastrointestinal (GI) toxicity. Secondary endpoints were patient-reported quality of life (QOL) and biochemical recurrence (BcR).
Three patients received preoperative SBRT to 25 Gy and four received 30 Gy. Median follow-up was 18 months. Highest toxicity was grade 2 and 3 in six (85.7%) and one (14.3%) patients, respectively. All patients developed grade 2 erectile dysfunction and 4 of 7 (57%) developed grade 2 urinary incontinence (UI) within a month after surgery. One patient developed acute grade 3 UI, but there was no grade ≥ 4 toxicity. One patient experienced acute grade 2 hemorrhoidal bleeding. On QOL, acute GU complaints were common and peaked within 3 months. Bowel symptoms were mild. Two patients with pN+ experienced BcR.
Preoperative SBRT before robotic RP in HRCaP is feasible and safe. The severity of acute GU toxicity with preoperative SBRT may be worse than RP alone, while bowel toxicity was mild.
本研究旨在探讨术前立体定向体部放疗（SBRT）联合机器人辅助根治性前列腺切除术（RP）治疗高危前列腺癌（HRCaP）的安全性。许多HRCaP患者在RP术后需要辅助或挽救性放疗。在RP术前加用SBRT可能使患者免于后续长时间的放疗疗程。
符合条件的患者为NCC N HRCaP，先接受SBRT，前列腺和精囊总剂量25 Gy或30 Gy，分5次每日照射，31 - 45天后行机器人辅助RP及盆腔淋巴结清扫术。主要终点是急性泌尿生殖系统（GU）和胃肠道（GI）毒性的发生率。次要终点是患者报告的生活质量（QOL）和生化复发（BcR）。
3例患者接受术前SBRT至25 Gy，4例接受30 Gy。中位随访时间为18个月。毒性最高分级为2级的有6例（85.7%），3级的有1例（14.3%）。所有患者术后1个月内均出现2级勃起功能障碍，7例中有4例（57%）出现2级尿失禁（UI）。1例患者出现急性3级UI，但无≥4级毒性。1例患者出现急性2级痔出血。在生活质量方面，急性GU症状常见，在3个月内达到高峰。肠道症状较轻。2例pN +患者出现BcR。
HRCaP患者在机器人辅助RP术前进行SBRT是可行且安全的。术前SBRT导致的急性GU毒性严重程度可能比单纯RP更差，而肠道毒性较轻。
