经会阴超声图像引导放疗治疗局限性前列腺癌的疗效。

Treatment outcome of localized prostate cancer using transperineal ultrasound image-guided radiotherapy.

机构信息

Department of Radiology, Yamagata City Hospital Saiseikan, Yamagata, Japan.

Central Radiology Center, Yamagata City Hospital Saiseikan, Yamagata, Japan.

出版信息

Radiat Oncol. 2024 Aug 1;19(1):100. doi: 10.1186/s13014-024-02490-x.

DOI:10.1186/s13014-024-02490-x

PMID:39090614

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11292876/

Abstract

BACKGROUND

We report the results of a retrospective analysis of localized prostate cancer (LPCa) treated with transperineal ultrasound image-guided radiotherapy (TPUS-IGRT).

METHODS

A total of 124 patients (median age: 74 y, 46-84 y) with LPCa who underwent TPUS-IGRT (Clarity Autoscan system; CAS, Elekta; Stockholm, Sweden) between April 2016 and October 2021 for curative/after hormone induction were enrolled. The number of patients by risk (National Comprehensive Cancer Network 2019) was 7, 25, 42, and 50 for low (LR), good intermediate (good IR), poor intermediate (poor IR), and high (HR)/very high (VHR), respectively. Ninety-five patients were given neoadjuvant hormonal therapy. The planning target volume margin setting was 3 mm for rectal in most cases, 5-7 mm for superior/inferior, and 5 mm for anterior/right/left. The principle prescribed dose is 74 Gy (LR), 76 Gy (good IR), and 76-78 Gy (poor IR or above). CAS was equipped with a real-time prostate intrafraction monitoring (RTPIFM) system. When a displacement of 2-3 mm or more was detected, irradiation was paused, and the patients were placed on standby for prostate reinstatement/recorrection. Of the 3135 fractions in 85 patients for whom RTPIFM was performed, 1008 fractions (32.1%) were recorrected at least once after starting irradiation.

RESULTS

A total of 123 patients completed the radiotherapy course. The 5-year overall survival rate was 95.9%. The 5-year biological prostate-specific antigen relapse-free survival rate (bPFS) was 100% for LR, 92.9% for intermediate IR, and 93.2% for HR/VHR (Phoenix method). The 5-year late toxicity rate of Grade 2+ was 7.4% for genitourinary (GU) and 6.5% for gastrointestinal (GI) organs. Comparing the ≤ 76 Gy group to the 78 Gy group for both GU and GI organs, the incidence was higher in the 78 Gy group for both groups.

CONCLUSION

These results suggest that TPUS-IGRT is well tolerated, as the bPFS and incidence of late toxicity are almost comparable to those reported by other sources of image-guided radiotherapy.

摘要

背景

我们报告了经会阴超声图像引导放疗（TPUS-IGRT）治疗局限性前列腺癌（LPCa）的回顾性分析结果。

方法

共纳入 124 例（中位年龄：74 岁，46-84 岁）接受 TPUS-IGRT（Clarity Autoscan 系统；CAS，Elekta；斯德哥尔摩，瑞典）治疗的 LPCa 患者，这些患者于 2016 年 4 月至 2021 年 10 月接受治疗，目的为根治性治疗/激素诱导后治疗。按风险（2019 年美国国家综合癌症网络）分组，低危（LR）、中危（良好 IR）、中危（不良 IR）和高危（HR）/极高危（VHR）患者分别为 7、25、42 和 50 例。95 例患者接受新辅助激素治疗。直肠靶区外放 3mm，上、下、前、右、左分别外放 5-7mm 和 5mm。原则上处方剂量为 LR 组 74Gy、良好 IR 组 76Gy、不良 IR 或以上组 76-78Gy。CAS 配备实时前列腺分次内监测（RTPIFM）系统。当检测到 2-3mm 或更大的位移时，照射暂停，患者等待前列腺复位/校正。在 85 例接受 RTPIFM 的患者中，有 3135 个分次中有 1008 个（32.1%）在开始照射后至少校正一次。

结果

共有 123 例患者完成放疗。5 年总生存率为 95.9%。LR 组 5 年生物前列腺特异性抗原无复发生存率（bPFS）为 100%，中间 IR 组为 92.9%，HR/VHR 组为 93.2%（Phoenix 方法）。5 年泌尿系统（GU）和胃肠道（GI）器官 2+ 级以上迟发性毒性发生率分别为 7.4%和 6.5%。与 GU 和 GI 器官的≤76Gy 组相比，78Gy 组的发生率更高。