Poon Darren M C, Yuan Jing, Yang Bin, Wong Oi-Lei, Chiu Sin-Ting, Chiu George, Cheung Kin-Yin, Yu Siu-Ki, Yung Raymond W H
Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China.
Research Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China.
Cancers (Basel). 2022 Jul 18;14(14):3484. doi: 10.3390/cancers14143484.
Background: Conventionally fractionated whole-pelvic nodal radiotherapy (WPRT) improves clinical outcome compared to prostate-only RT in high-risk prostate cancer (HR-PC). MR-guided stereotactic body radiotherapy (MRgSBRT) with concomitant WPRT represents a novel radiotherapy (RT) paradigm for HR-PC, potentially improving online image guidance and clinical outcomes. This study aims to report the preliminary clinical experiences and treatment outcome of 1.5 Tesla adaptive MRgSBRT with concomitant WPRT in HR-PC patients. Materials and methods: Forty-two consecutive HR-PC patients (72.5 ± 6.8 years) were prospectively enrolled, treated by online adaptive MRgSBRT (8 Gy(prostate)/5 Gy(WPRT) × 5 fractions) combined with androgen deprivation therapy (ADT) and followed up (median: 251 days, range: 20−609 days). Clinical outcomes were measured by gastrointestinal (GI) and genitourinary (GU) toxicities according to the Common Terminology Criteria for Adverse Events (CTCAE) Scale v. 5.0, patient-reported quality of life (QoL) with EPIC (Expanded Prostate Cancer Index Composite) questionnaire, and prostate-specific antigen (PSA) responses. Results: All MRgSBRT fractions achieved planning objectives and dose specifications of the targets and organs at risk, and they were successfully delivered. The maximum cumulative acute GI/GU grade 1 and 2 toxicity rates were 19.0%/81.0% and 2.4%/7.1%, respectively. The subacute (>30 days) GI/GU grade 1 and 2 toxicity rates were 21.4%/64.3% and 2.4%/2.4%, respectively. No grade 3 toxicities were reported. QoL showed insignificant changes in urinary, bowel, sexual, and hormonal domain scores during the follow-up period. All patients had early post-MRgSBRT biochemical responses, while biochemical recurrence (PSA nadir + 2 ng/mL) occurred in one patient at month 18. Conclusions: To our knowledge, this is the first prospective study that showed the clinical outcomes of MRgSBRT with concomitant WPRT in HR-PC patients. The early results suggested favorable treatment-related toxicities and encouraging patient-reported QoLs, but long-term follow-up is needed to confirm our early results.
在高危前列腺癌（HR-PC）中，与仅针对前列腺的放疗相比，传统分割的全盆腔淋巴结放疗（WPRT）可改善临床结局。联合WPRT的磁共振引导立体定向体部放疗（MRgSBRT）代表了一种针对HR-PC的新型放疗模式，可能改善在线图像引导和临床结局。本研究旨在报告1.5特斯拉自适应MRgSBRT联合WPRT治疗HR-PC患者的初步临床经验和治疗结果。
前瞻性纳入42例连续的HR-PC患者（72.5±6.8岁），采用在线自适应MRgSBRT（8 Gy（前列腺）/5 Gy（WPRT）×5次分割）联合雄激素剥夺治疗（ADT），并进行随访（中位时间：251天，范围：20 - 609天）。根据不良事件通用术语标准（CTCAE）第5.0版，通过胃肠道（GI）和泌尿生殖系统（GU）毒性、采用EPIC（扩展前列腺癌指数综合问卷）进行患者报告的生活质量（QoL）评估以及前列腺特异性抗原（PSA）反应来衡量临床结局。
所有MRgSBRT分割均达到靶区和危及器官的计划目标及剂量规范，并成功实施。最大累积急性GI/GU 1级和2级毒性发生率分别为19.0%/81.0%和2.4%/7.1%。亚急性（>30天）GI/GU 1级和2级毒性发生率分别为21.4%/64.3%和2.4%/2.4%。未报告3级毒性。随访期间，QoL在泌尿、肠道、性和激素领域得分无显著变化。所有患者在MRgSBRT后均有早期生化反应，1例患者在第18个月出现生化复发（PSA最低点 + 2 ng/mL）。
据我们所知，这是第一项显示MRgSBRT联合WPRT治疗HR-PC患者临床结局的前瞻性研究。早期结果提示治疗相关毒性良好，患者报告的QoL令人鼓舞，但需要长期随访以证实我们的早期结果。
