Sosa Alan J, Thames Howard D, Sanders Jeremiah W, Choi Seungtaek L, Nguyen Quynh-Nhu, Mok Henry, Ron Zhu X, Shah Shalin, Mayo Lauren L, Hoffman Karen E, Tang Chad, Lee Andrew K, Pugh Thomas J, Kudchadker Reena, Frank Steven J
Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Radiother Oncol. 2023 Nov;188:109854. doi: 10.1016/j.radonc.2023.109854. Epub 2023 Aug 18.
Proton therapy (PT) has emerged as a standard-of-care treatment option for localized prostate cancer at our comprehensive cancer center. However, there are few large-scale analyses examining the long-term clinical outcomes. Therefore, this article aims to evaluate the long-term effectiveness and toxicity of PT in patients with localized prostate cancer.
Review of 2772 patients treated from May 2006 through January 2020. Disease risk was stratified according to National Comprehensive Cancer Network guidelines as low [LR, n = 640]; favorable-intermediate [F-IR, n = 850]; unfavorable-intermediate [U-IR, n = 851]; high [HR, n = 315]; or very high [VHR, n = 116]. Biochemical failure and toxicity were analyzed using Kaplan-Meier estimates and multivariate models.
The median patient age was 66 years; the median follow-up time was 7.0 years. Pelvic lymph node irradiation was prescribed to 28 patients (1%) (2 [0.2%] U-IR, 11 [3.5%] HR, and 15 [12.9%] VHR). The median dose was 78 Gy in 1.8-2.0 Gy(RBE) fractions. Freedom from biochemical relapse (FFBR) rates at 5 years and 10 years were 98.2% and 96.8% for the LR group; 98.3% and 93.6%, F-IR; 94.2% and 90.2%, U-IR; 94.3% and 85.2%, HR; and 86.1% and 68.5%, VHR. Two patients died of prostate cancer. Overall rates of late grade ≥ 3 GU and GI toxicity were 0.87% and 1.01%.
Proton therapy for localized prostate cancer demonstrated excellent clinical outcomes in this large cohort, even among higher-risk groups with historically poor outcomes despite aggressive therapy.
质子治疗（PT）已成为我们综合癌症中心局部前列腺癌的标准治疗选择。然而，很少有大规模分析来研究其长期临床结果。因此，本文旨在评估PT治疗局部前列腺癌患者的长期有效性和毒性。
回顾2006年5月至2020年1月期间接受治疗的2772例患者。根据美国国立综合癌症网络指南将疾病风险分层为低风险[LR，n = 640]；有利中风险[F-IR，n = 850]；不利中风险[U-IR，n = 851]；高风险[HR，n = 315]；或极高风险[VHR，n = 116]。使用Kaplan-Meier估计和多变量模型分析生化失败和毒性。
患者中位年龄为66岁；中位随访时间为7.0年。28例患者（1%）接受盆腔淋巴结照射（2例[0.2%]U-IR，11例[3.5%]HR，15例[12.9%]VHR）。中位剂量为78 Gy，分1.8 - 2.0 Gy（相对生物效应）分次给予。LR组5年和10年无生化复发（FFBR）率分别为98.2%和96.8%；F-IR组为98.3%和93.6%；U-IR组为94.2%和90.2%；HR组为94.3%和85.2%；VHR组为86.1%和68.5%。2例患者死于前列腺癌。晚期≥3级泌尿生殖系统（GU）和胃肠道（GI）毒性的总体发生率分别为0.87%和1.01%。
在这个大型队列中，质子治疗局部前列腺癌显示出优异的临床结果，即使在既往积极治疗但预后较差的高风险组中也是如此。
