Yamazaki Hideya, Suzuki Gen, Aibe Norihiro, Shimizu Daisuke, Kimoto Takuya, Masui Koji, Yoshida Ken, Nakamura Satoaki, Hashimoto Yasutoshi, Okabe Haruumi
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto 602-8566, Japan.
Department of Radiology, Kansai Medical University, Hirakata 573-1010, Japan.
Cancers (Basel). 2021 Dec 31;14(1):195. doi: 10.3390/cancers14010195.
The purpose of this study was to compare the toxicity (first endpoint) and efficacy (second endpoint) of ultrahypofractionated radiotherapy (UHF) and dose-escalated conventional to moderate hypofractionated radiotherapy (DeRT) for clinically localized prostate cancer. We compared 253 patients treated with UHF and 499 patients treated with DeRT using multi-institutional retrospective data. To analyze toxicity, we divided UHF into High-dose UHF (H-UHF; equivalent doses of 2 Gy per fraction: EQD2 > 100 Gy) and low-dose UHF (L-UHF; EQD2 ≤ 100 Gy). In toxicity, H-UHF elevated for 3 years accumulated late gastrointestinal and genitourinary toxicity grade ≥ 2 (11.1% and 9.3%) more than L-UHF (3% and 1.2%) and DeRT (3.1% and 4.8%, = 0.00126 and = 0.00549). With median follow-up periods of 32.0 and 61.7 months, the actuarial 3-year biochemical failure-free survival rates were 100% (100% and 100% in the L-UHF and H-UHF) and 96.3% in the low-risk group, 96.5% (97.1% and 95.6%) and 94.9% in the intermediate-risk group, and 93.7% (100% and 94.6%) and 91.7% in the high-risk group in the UHF and DeRT groups, respectively. UHF showed equivocal efficacy, although not conclusive but suggestive due to a short follow-up period of UHF. L-UHF using EQD2 ≤ 100 Gy is a feasible UHF schedule with a good balance between toxicity and efficacy.
本研究的目的是比较超分割放疗（UHF）与剂量递增的传统至中度分割放疗（DeRT）对临床局限性前列腺癌的毒性（首要终点）和疗效（次要终点）。我们使用多机构回顾性数据，比较了253例接受UHF治疗的患者和499例接受DeRT治疗的患者。为分析毒性，我们将UHF分为高剂量UHF（H-UHF；每分次等效剂量2 Gy：等效剂量2（EQD2）>100 Gy）和低剂量UHF（L-UHF；EQD2≤100 Gy）。在毒性方面，H-UHF在3年内累积的晚期胃肠道和泌尿生殖系统毒性≥2级（分别为11.1%和9.3%）高于L-UHF（分别为3%和1.2%）和DeRT（分别为3.1%和4.8%，P = 0.00126和P = 0.00549）。中位随访期分别为32.0个月和61.7个月，低危组的3年精算无生化失败生存率在L-UHF和H-UHF组中均为100%，在DeRT组中为96.3%；中危组在UHF和DeRT组中分别为96.5%（97.1%和95.6%）和94.9%；高危组在UHF和DeRT组中分别为93.7%（100%和94.6%）和91.7%。尽管由于UHF随访期短，结果不确凿但具有提示性，UHF的疗效仍不明确。使用EQD2≤100 Gy的L-UHF是一种可行的UHF方案，在毒性和疗效之间具有良好的平衡。
