Gregucci Fabiana, Carbonara Roberta, Surgo Alessia, Ciliberti Maria Paola, Curci Domenico, Ciocia Annarita, Branà Luciana, Ludovico Giuseppe Mario, Scarcia Marcello, Portoghese Filippo, Caliandro Morena, Ludovico Elena, Paulicelli Eleonora, Di Guglielmo Fiorella Cristina, Bonaparte Ilaria, Fiorentino Alba
Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy.
Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy.
Radiol Med. 2023 Apr;128(4):501-508. doi: 10.1007/s11547-023-01618-5. Epub 2023 Mar 23.
Aim of this study is to evaluate safety and efficacy of SBRT in elderly patients affected by localized prostate cancer (PC).
Men aged 70 years or older were enrolled and analyzed. The SBRT schedule was 35 Gy in 5 fractions administered in 1-2 weeks. According to risk group, androgen deprivation therapy (ADT) was prescribed. Urinary symptoms were evaluated at baseline using the International Prostate Symptom Score (IPSS). Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed at the end of treatment, 2 weeks after SBRT and during follow-up using the Common Terminology Criteria for Adverse Events (CTCAE). PSA values were recorded before treatment and during follow-up as biochemical response criteria.
Between 07/2019 and 09/2021, 111 patients were enrolled. Median age was 77 years. At the end of treatment, no acute GU/GI toxicities ≥ G2 were observed. At 2-3 weeks after treatment, 3 patients reported G2 GU toxicity, while 14 patients referred G2 GI toxicity. During the last follow up, 26 and 2 patients reported, respectively, G1 and G2 GU toxicity, while 22 and 1 cases described, respectively, G1 and G2 GI toxicity. No late toxicities ≥ G3 were recorded. GU toxicity is related to absence of urethra sparing, increasing PTV volume, Dmax PTV and IPSS; GI toxicity is related to RT schedule (each other day is better than consecutive day), Dmax rectum and IPSS, At a median follow-up of 24 months, excellent biochemical disease control was achieved in all cases with median PSA of 0.5 ng/ml.
SBRT in elderly patients affected by PC is feasible and well tolerated with excellent biochemical disease control. Longer follow-up is needed to assess late toxicity profile and long-term clinical outcome.
本研究旨在评估立体定向体部放疗（SBRT）对老年局限性前列腺癌（PC）患者的安全性和有效性。
纳入并分析70岁及以上男性患者。SBRT方案为在1 - 2周内分5次给予35 Gy。根据风险组给予雄激素剥夺治疗（ADT）。使用国际前列腺症状评分（IPSS）在基线时评估泌尿症状。在治疗结束时、SBRT后2周以及随访期间，使用不良事件通用术语标准（CTCAE）评估泌尿生殖系统（GU）和胃肠道（GI）毒性。记录治疗前和随访期间的PSA值作为生化反应标准。
在2019年7月至2021年9月期间，共纳入111例患者。中位年龄为77岁。治疗结束时，未观察到≥G2级的急性GU/GI毒性。治疗后2 - 3周，3例患者报告G2级GU毒性，14例患者报告G2级GI毒性。在末次随访时，分别有26例和2例患者报告G1级和G2级GU毒性，分别有22例和1例患者描述G1级和G2级GI毒性。未记录到≥G3级的晚期毒性。GU毒性与未保留尿道、PTV体积增加、PTV的Dmax和IPSS有关；GI毒性与放疗方案（隔日放疗优于连续放疗）、直肠Dmax和IPSS有关。中位随访24个月时，所有病例均实现了良好的生化疾病控制，中位PSA为0.5 ng/ml。
SBRT对老年PC患者是可行的，耐受性良好，且生化疾病控制良好。需要更长时间的随访来评估晚期毒性特征和长期临床结局。
