Lischalk Jonathan W, Akerman Meredith, Repka Michael C, Sanchez Astrid, Mendez Christopher, Santos Vianca F, Carpenter Todd, Wise David, Corcoran Anthony, Lepor Herbert, Katz Aaron, Haas Jonathan A
Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States.
Division of Health Services Research, New York University Long Island School of Medicine, New York University Langone Health, Mineola, NY, United States.
Front Oncol. 2024 Feb 6;14:1325200. doi: 10.3389/fonc.2024.1325200. eCollection 2024.
Modern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In this study, we explore the outcomes of the largest cohort to date, which uses a stereotactic body radiation therapy (SBRT) boost following pelvic nodal radiation for exclusively high-risk prostate cancer.
A large institutional database was interrogated to identify all patients with high-risk clinical node-negative prostate cancer treated with conventionally fractionated radiotherapy to the pelvis followed by a robotic SBRT boost to the prostate and seminal vesicles. The boost was uniformly delivered over three fractions. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Oncologic outcomes were assessed using the Kaplan-Meier method. Cox proportional hazard models were created to evaluate associations between pretreatment characteristics and clinical outcomes.
A total of 440 patients with a median age of 71 years were treated, the majority of whom were diagnosed with a grade group 4 or 5 disease. Pelvic nodal irradiation was delivered at a total dose of 4,500 cGy in 25 fractions, followed by a three-fraction SBRT boost. With an early median follow-up of 2.5 years, the crude incidence of grade 2+ genitourinary (GU) and gastrointestinal (GI) toxicity was 13% and 11%, respectively. Multivariate analysis revealed grade 2+ GU toxicity was associated with older age and a higher American Joint Committee on Cancer (AJCC) stage. Multivariate analysis revealed overall survival was associated with patient age and posttreatment prostate-specific antigen (PSA) nadir.
Utilization of an SBRT boost following pelvic nodal irradiation in the treatment of high-risk prostate cancer is oncologically effective with early follow-up and yields minimal high-grade toxicity. We demonstrate a 5-year freedom from biochemical recurrence (FFBCR) of over 83% with correspondingly limited grade 3+ GU and GI toxicity measured at 3.6% and 1.6%, respectively. Long-term follow-up is required to evaluate oncologic outcomes and late toxicity.
现代文献表明，在高危前列腺癌的治疗中，采用预防性盆腔淋巴结照射后加近距离放疗强化，可改善长期生化结局。然而，这是以增加治疗相关毒性为代价的。在本研究中，我们探讨了迄今为止最大队列的治疗结果，该队列在盆腔淋巴结放疗后采用立体定向体部放疗（SBRT）强化，专门用于治疗高危前列腺癌。
查询一个大型机构数据库，以识别所有高危临床淋巴结阴性前列腺癌患者，这些患者接受了盆腔常规分割放疗，随后对前列腺和精囊进行机器人SBRT强化。强化治疗均匀分三次进行。使用不良事件通用术语标准（CTCAE）第5.0版测量毒性。采用Kaplan-Meier方法评估肿瘤学结局。建立Cox比例风险模型以评估治疗前特征与临床结局之间的关联。
共治疗440例患者，中位年龄71岁，其中大多数被诊断为4级或5级疾病。盆腔淋巴结照射总剂量为4500 cGy，分25次进行，随后进行三次SBRT强化。中位随访2.5年时，2级及以上泌尿生殖系统（GU）和胃肠道（GI）毒性的粗发病率分别为13%和11%。多因素分析显示，2级及以上GU毒性与年龄较大和美国癌症联合委员会（AJCC）分期较高有关。多因素分析显示，总生存与患者年龄和治疗后前列腺特异性抗原（PSA）最低点有关。
在高危前列腺癌治疗中，盆腔淋巴结照射后采用SBRT强化在早期随访中具有肿瘤学疗效，且产生的高级别毒性最小。我们证明5年无生化复发（FFBCR）率超过83%，相应地，3级及以上GU和GI毒性分别为3.6%和1.6%，有限。需要长期随访以评估肿瘤学结局和晚期毒性。
