Quintin K, Créhange G, Graff P
Service d'oncologie-radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
Service d'oncologie-radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
Cancer Radiother. 2024 Aug;28(4):333-340. doi: 10.1016/j.canrad.2024.01.005. Epub 2024 Aug 17.
Prostate cancer is the most frequent cancer among men and radiotherapy hypofractionation regimens have become standard treatments for the localized stages, but the absence of increased risk of acute and late genitourinary or gastrointestinal toxicity of the dose escalation still must be demonstrated.
The study population included all patients with localized prostatic adenocarcinoma treated at the institut Curie from February 2016 to March 2018 by external radiation delivered by a linear accelerator using an image-guided conformal intensity modulation technique at a total dose of 75Gy in 30 fractions of 2.5Gy in the planning target volume that included the prostate and the proximal seminal vesicles, and could be paired with a prophylactic lymph node radiotherapy at 46Gy in 23 fractions with simultaneous integrated boost.
A total of 166 patients were included. Among them, 68.6% were unfavourable intermediate or (very) high risk. The median age and follow-up were 71.4years and 3.96years. One hundred and forty-nine patients received prophylactic lymph node radiotherapy (89.8%). One hundred and thirty-one patients received hormonotherapy (78.9%). Genito-urinary toxicity events of grades 2 or above during radiotherapy, at 6months, 1year and 5years were respectively 36.7%, 8.8%, 3.1% and 4.7%. Two patients had late grade 4 toxicity at 5years (1.6%). Grade 2 gastrointestinal toxicity events during radiotherapy, 6months, 1year and 5years were respectively 15.1%, 1.9%, 14.6% and 9.3%. Of these, eight patients had grade 3 toxicity (6.2%). There was no grade 4 toxicity. Analyses did not reveal any predictive factor for toxicity. The 5-year overall, progression-free, and specific survival rates were respectively 82.4%, 85.7%, and 93.3%. Serum prostate specific antigen concentration and cardiovascular risk factors were found to be predictive factors of deterioration in overall survival (P=0.0028 for both).
External radiotherapy for localized prostatic cancer with our moderately hypofractionated dose escalation regimen is well tolerated. In the absence of increased late toxicity, the analysis of the modes of long-term relapses will be interesting to determine the benefit of this dose escalation on local and distant relapses.
前列腺癌是男性中最常见的癌症，放疗超分割方案已成为局限性前列腺癌阶段的标准治疗方法，但仍必须证明剂量递增不会增加急性和晚期泌尿生殖系统或胃肠道毒性的风险。
研究人群包括2016年2月至2018年3月在居里研究所接受治疗的所有局限性前列腺腺癌患者，采用直线加速器进行外照射，使用图像引导适形调强技术，计划靶体积（包括前列腺和近端精囊）的总剂量为75Gy，分30次，每次2.5Gy，并且可以与预防性淋巴结放疗联合，预防性淋巴结放疗剂量为46Gy，分23次，同时进行同步整合加量。
共纳入166例患者。其中，68.6%为不良中危或（极）高危患者。中位年龄和随访时间分别为71.4岁和3.96年。149例患者接受了预防性淋巴结放疗（89.8%）。131例患者接受了激素治疗（78.9%）。放疗期间、6个月、1年和5年时2级及以上泌尿生殖系统毒性事件的发生率分别为36.7%、8.8%、3.1%和4.7%。2例患者在5年时出现晚期4级毒性（1.6%）。放疗期间、6个月、1年和5年时2级胃肠道毒性事件的发生率分别为15.1%、1.9%、14.6%和9.3%。其中，8例患者出现3级毒性（6.2%）。无4级毒性。分析未发现任何毒性预测因素。5年总生存率、无进展生存率和特异性生存率分别为82.4%、85.7%和93.3%。血清前列腺特异性抗原浓度和心血管危险因素被发现是总生存恶化的预测因素（两者P均=0.0028）。
采用我们的中度超分割剂量递增方案对局限性前列腺癌进行外放疗耐受性良好。在没有增加晚期毒性的情况下，分析长期复发模式对于确定这种剂量递增对局部和远处复发的益处将很有意义。
