Laughlin Brady S, Silva Alvin C, Vora Sujay A, Keole Sameer R, Wong William W, Schild Michael H, Schild Steven E
Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States.
Department of Radiology, Mayo Clinic, Phoenix, AZ, United States.
Front Oncol. 2022 Aug 10;12:921465. doi: 10.3389/fonc.2022.921465. eCollection 2022.
PURPOSE/OBJECTIVES: This retrospective study demonstrates the long-term outcomes of treating prostate cancer using intensity modulated (IMRT) with incorporation of MRI-directed boost.
MATERIALS/METHODS: From February 2009 to February 2013, 78 men received image-guided IMRT delivering 77.4 Gy in 44 fractions with simultaneously integrated boost to 81-83 Gy to an MRI-identified lesion. Patients with intermediate-risk or high-risk prostate cancer were recommended to receive 6 and 24-36 months of adjuvant hormonal therapy, respectively.
Median follow-up was 113 months (11-147). There were 18 low-risk, 43 intermediate-risk, and 17 high-risk patients per NCCN risk stratification included in this study. Adjuvant hormonal therapy was utilized in 32 patients (41%). The 10-year biochemical control rate for all patients was 77%. The 10-year biochemical control rates for low-risk, intermediate-risk, and high-risk diseases were 94%, 81%, and 88%, respectively (p = 0.35). The 10-year rates of local control, distant control, and survival were 99%, 88%, and 66%, respectively. Of 25 patients who died, only four (5%) died of prostate cancer. On univariate analysis, T-category and pretreatment PSA level were associated with distant failure rate (p = 0.02). There was no grade =3 genitourinary and gastrointestinal toxicities that persisted at the last follow-up.
This study demonstrated the long-term efficacy of using MRI to define an intra-prostatic lesion for SIB to 81-83Gy while treating the entire prostate gland to 77.4 Gy with IMRT. Our study confirms that modern MRI can be used to locally intensify dose to prostate tumors providing high long-term disease control while maintaining favorable long-term toxicity.
目的/目标：这项回顾性研究展示了采用调强放疗（IMRT）联合MRI引导下的剂量递增治疗前列腺癌的长期疗效。
材料/方法：2009年2月至2013年2月，78名男性接受了影像引导的IMRT，分44次给予77.4 Gy的剂量，同时对MRI识别出的病灶同步加量至81 - 83 Gy。中危或高危前列腺癌患者分别被推荐接受6个月和24 - 36个月的辅助激素治疗。
中位随访时间为113个月（11 - 147个月）。本研究纳入了根据美国国立综合癌症网络（NCCN）风险分层的18例低危、43例中危和17例高危患者。32例患者（41%）接受了辅助激素治疗。所有患者的10年生化控制率为77%。低危、中危和高危疾病的10年生化控制率分别为94%、81%和88%（p = 0.35）。10年局部控制率、远处控制率和生存率分别为99%、88%和66%。在25例死亡患者中，只有4例（5%）死于前列腺癌。单因素分析显示，T分期和治疗前前列腺特异性抗原（PSA）水平与远处失败率相关（p = 0.02）。末次随访时没有持续存在的3级泌尿生殖系统和胃肠道毒性反应。
本研究证明了在采用IMRT将整个前列腺腺体治疗至77.4 Gy的同时，利用MRI定义前列腺内病灶进行同步整合加量至81 - 83 Gy的长期疗效。我们的研究证实，现代MRI可用于局部增加前列腺肿瘤的剂量，在保持良好的长期毒性的同时提供高长期疾病控制率。
