Mose Lucas, Loebelenz Laura Isabel, Althaus Alexander, Ahmadsei Maiwand, Mathier Etienne, Broemel Isabelle, Aebersold Daniel M, Obmann Verena Carola, Shelan Mohamed
Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Strahlenther Onkol. 2025 Jan 14. doi: 10.1007/s00066-024-02355-y.
This study aimed to evaluate the prognostic significance of magnetic resonance imaging (MRI) parameters on biochemical failure-free survival (BFS) in patients diagnosed with intermediate-risk prostate cancer and treated with robotic ultrahypofractionated stereotactic body radiotherapy (SBRT) without androgen deprivation therapy (ADT).
A retrospective analysis was conducted in patients with intermediate-risk prostate cancer undergoing robotic SBRT delivered in five fractions with a total radiation dose of 35-36.25 Gy. The primary endpoint was biochemical failure as defined by the Phoenix criteria. Among other clinicopathological data, T stage, Prostate Imaging-Reporting and Data System (PI-RADS) score, and multiparametric magnetic resonance imaging-based extra-prostatic extension (mEPE) score were collected and analyzed using the log-rank test.
A total of 74 patients were eligible for analysis. Median age at treatment was 68.8 years and median prostate volume was 47.8 cm. Fifty-four and 14 patients were diagnosed with Gleason scores 7a and 7b, respectively. In total, 40 patients were classified as having unfavorable intermediate-risk prostate cancer according to American Urological Association/American Society for Radiation Oncology/ Society of Urologic Oncology (AUA/ASTRO/SUO) guidelines. The median follow-up was 30 months (range: 4-91.2 months; interquartile range (IQR): 18.5-48 months). The 3‑year BFS was 92%. A total of 12 (16.2%) biochemical failures were reported. In univariate analysis, an mEPE score of 5, the delivered total radiation dose (35 Gy vs. 36.25 Gy), and a prostate-specific antigen (PSA) nadir >1 ng/ml were associated with lower BFS (mEPE-BFS: p < 0.001, total radiation dose-BFS: p = 0.04, PSA nadir-BFS: p =< 0.001).
Patients diagnosed with intermediate-risk prostate cancer with a high mEPE score are more likely to experience biochemical failure after SBRT. Treatment intensification measures, such as administration of concomitant ADT, should be considered.
本研究旨在评估磁共振成像（MRI）参数对诊断为中危前列腺癌且接受机器人超分割立体定向体部放疗（SBRT）且未接受雄激素剥夺治疗（ADT）的患者无生化失败生存（BFS）的预后意义。
对接受机器人SBRT、分5次进行、总辐射剂量为35 - 36.25 Gy的中危前列腺癌患者进行回顾性分析。主要终点为根据Phoenix标准定义的生化失败。除其他临床病理数据外，收集T分期、前列腺影像报告和数据系统（PI-RADS）评分以及基于多参数磁共振成像的前列腺外扩展（mEPE）评分，并使用对数秩检验进行分析。
共有74例患者符合分析条件。治疗时的中位年龄为68.8岁，中位前列腺体积为47.8 cm³。分别有54例和14例患者被诊断为Gleason评分7a和7b。根据美国泌尿外科学会/美国放射肿瘤学会/泌尿肿瘤学会（AUA/ASTRO/SUO）指南，共有40例患者被归类为具有不良中危前列腺癌。中位随访时间为30个月（范围：4 - 91.2个月；四分位间距（IQR）：18.5 - 48个月）。3年BFS为92%。共报告了12例（16.2%）生化失败。在单因素分析中，mEPE评分为5、总辐射剂量（35 Gy与36.25 Gy）以及前列腺特异性抗原（PSA）最低点>1 ng/ml与较低的BFS相关（mEPE - BFS：p < 0.001，总辐射剂量 - BFS：p = 0.04，PSA最低点 - BFS：p < 0.001）。
诊断为中危前列腺癌且mEPE评分高的患者在SBRT后更有可能发生生化失败。应考虑强化治疗措施，如给予同步ADT。
