Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka-shi, Osaka 550-0025, Japan.
Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka-shi, Osaka 550-0025, Japan.
J Radiat Res. 2023 Sep 22;64(5):850-856. doi: 10.1093/jrr/rrad060.
This study investigated the outcomes of whole-pelvis radiation therapy (WPRT) using volumetric modulated arc therapy (VMAT) for high-risk prostate cancer. We retrospectively analysed 112 patients with high-risk prostate cancer who started WPRT at our hospital between August 2011 and August 2015. The prescribed dose was 78 Gy in 39 fractions to the prostate and 46.8 Gy in 26 fractions to the pelvic lymph node (LN) area. All patients received long-term androgen deprivation therapy. We evaluated late gastrointestinal (GI) and genitourinary (GU) toxicities using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period for censored cases was 97 (interquartile range [IQR] = 85-108) months. The median age was 72 (IQR = 67-75) years. The high-risk and very-high-risk groups included 41 (36.6%) and 71 patients (63.4%), respectively. The median risk of LN invasion calculated by the Roach formula was 36.9 (IQR = 26.6-56.3) %. The 8-year overall survival, biochemical failure-free survival, disease-free survival and distant metastasis-free survival rates were 88.4, 91.9, 83.8 and 98.0%, respectively. Only one patient experienced common iliac LN recurrence, which was outside the pelvic irradiation area. All patients with recurrent disease were categorized into the very-high-risk group. The 8-year cumulative rates of ≥Grade 2 late GI and GU toxicities were 12.8 and 11.8%, respectively. No patients experienced Grade 4 or higher toxicities. WPRT using VMAT for high-risk prostate cancer was well tolerated and effective.
本研究调查了使用容积旋转调强放疗（VMAT）治疗高危前列腺癌的全骨盆放疗（WPRT）的结果。我们回顾性分析了 2011 年 8 月至 2015 年 8 月期间在我院接受 WPRT 的 112 例高危前列腺癌患者。前列腺的处方剂量为 78 Gy，39 次；盆腔淋巴结（LN）区域为 46.8 Gy，26 次。所有患者均接受长期雄激素剥夺治疗。我们使用通用不良事件术语标准 4.0 评估晚期胃肠道（GI）和泌尿生殖系统（GU）毒性。截止病例的中位随访时间为 97（四分位距[IQR] = 85-108）个月。中位年龄为 72（IQR = 67-75）岁。高危和极高危组分别包括 41（36.6%）和 71 例（63.4%）患者。Roach 公式计算的 LN 侵犯风险中位数为 36.9（IQR = 26.6-56.3）%。8 年总生存率、生化无失败生存率、无病生存率和远处转移无复发生存率分别为 88.4%、91.9%、83.8%和 98.0%。仅有 1 例患者发生髂总 LN 复发，且位于骨盆照射区域之外。所有复发患者均归入极高危组。8 年≥2 级晚期 GI 和 GU 毒性的累积发生率分别为 12.8%和 11.8%。无患者发生 4 级或更高毒性。高危前列腺癌的 WPRT 联合 VMAT 放疗具有良好的耐受性和有效性。
