Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Korea.
J Med Imaging Radiat Oncol. 2024 Apr;68(3):333-341. doi: 10.1111/1754-9485.13639. Epub 2024 Mar 13.
This study aimed to analyse the treatment outcomes of moderately hypofractionated radiation therapy (RT) combined with androgen deprivation therapy (ADT) and the prognostic implications of prostate-specific antigen (PSA) kinetics in high-risk localized prostate cancer.
The medical records of 140 patients who underwent definitive RT (70 Gy in 28 fractions) combined with ADT were retrospectively reviewed. ADT consists of a gonadotropin-releasing hormone agonist and an anti-androgen. Clinical outcomes included the biochemical failure rate (BFR), clinical failure rate (CFR), overall survival (OS) and prostate cancer-specific survival (PCSS). The BFR and CFR were stratified by the PSA nadir and the time to the PSA nadir, respectively. Acute and late genitourinary and gastrointestinal adverse events were also recorded.
The 5-year BFR, CFR, OS and PCSS rates were 9.8%, 4.5%, 90.2% and 98.7%, respectively. Ninety-five (67.9%) patients achieved a PSA nadir of 0.01 ng/mL. Patients with a PSA nadir >0.01 ng/mL had a significantly higher BFR and CFR (BFR, P = 0.001; CFR, P = 0.027), even after adjusting for other prognostic factors [per 0.1 ng/mL; BFR, hazard ratio (HR) 4.440, P < 0.001; CFR, HR 4.338, P = 0.001]. However, the time to the PSA nadir and pre-RT PSA were not significantly associated with the BFR and CFR. Six patients (4.3%) reported grade 3 late adverse events, mostly haematuria and haematochezia.
Definitive RT with moderate hypofractionation combined with long-term ADT showed good efficacy for high-risk localized prostate cancer. The lowest PSA nadir was significantly associated with a low recurrence rate, indicating the importance of PSA follow-up.
本研究旨在分析中分割放射治疗（RT）联合雄激素剥夺治疗（ADT）治疗中高危局限性前列腺癌的疗效，并探讨前列腺特异性抗原（PSA）动力学的预后意义。
回顾性分析 140 例接受根治性 RT（28 次分割，70Gy）联合 ADT 的患者的病历。ADT 包括促性腺激素释放激素激动剂和抗雄激素。临床结局包括生化失败率（BFR）、临床失败率（CFR）、总生存率（OS）和前列腺癌特异性生存率（PCSS）。BFR 和 CFR 分别按 PSA 最低点和 PSA 最低点时间进行分层。还记录了急性和晚期泌尿生殖系统和胃肠道不良事件。
5 年 BFR、CFR、OS 和 PCSS 率分别为 9.8%、4.5%、90.2%和 98.7%。95 例（67.9%）患者达到 PSA 最低点 0.01ng/mL。PSA 最低点>0.01ng/mL 的患者 BFR 和 CFR 显著升高（BFR，P=0.001；CFR，P=0.027），即使在调整其他预后因素后[每 0.1ng/mL；BFR，危险比（HR）4.440，P<0.001；CFR，HR 4.338，P=0.001]。然而，PSA 最低点时间和 RT 前 PSA 与 BFR 和 CFR 无显著相关性。6 例（4.3%）患者报告 3 级晚期不良事件，主要为血尿和血便。
中分割 RT 联合长期 ADT 治疗高危局限性前列腺癌疗效良好。最低 PSA 最低点与低复发率显著相关，表明 PSA 随访的重要性。
