Trofymov Artem, Bschleipfer Thomas, Aigner Thomas, Grabenbauer Gerhard G
Department of Radiation Oncology, Coburg Prostate Cancer Center, Ketschendorferstraße 33, 96450, Coburg, Germany.
Department of Department of Radiation Oncology, Institute for Medical Radiology, National Academy of Medical Sciences of Ukraine, Hrihoriia Skovorody 82, 61024, Kharkiv, Ukraine.
Strahlenther Onkol. 2025 Apr 10. doi: 10.1007/s00066-025-02392-1.
For patients with intermediate and high-risk prostate cancer, radiation treatment is a well-established alternative to surgery. Modern techniques, such as intensity-modulated radiation therapy and volumetric modulated arc therapy, allow for precise dose escalation to the tumor while minimizing exposure to surrounding healthy tissues. The purpose of this analysis was to assess the safety and efficacy of two different radiation treatment protocols (high dose vs low dose) in prostate cancer patients across all risk categories.
Between 2015 and 2021, a total of 300 consecutive patients with localized adenocarcinoma of the prostate underwent intensity-modulated radiation therapy and volumetric modulated arc therapy at this institution. The study's endpoints were overall survival, prostate cancer specific overall survival, metastases-free survival, biochemically no evidence of disease survival rates as well as acute and long-term toxic effects. Influence of patient- and treatment-related parameters, including risk stratification (low and medium vs. high risk), radiation therapy dose levels (< 76 Gy vs. ≥ 76 Gy), radiation therapy duration (≤ 51 days vs. > 51 days), treatment with or without elective node irradiation, and the use of concurrent androgen deprivation therapy was evaluated by the log-rank-test and using multivariate Cox-analysis.
Overall survival, prostate cancer specific overall survival, metastases-free survival and biochemically no evidence of disease survival rates were 88%, 96%, 94%, 92% and 56%, 76%, 90%, 75% at 5 and 10 years, respectively. Univariate analysis identified a significant impact of total dose and androgen deprivation therapy. Overall survival rates for patients with a total radiation dose ≥ 76 Gy were 92% and 59% at 5 and 10 years, respectively, in comparison with patients receiving a total dose of < 76 Gy having a 5-year overall survival of 82% and a 10-year of overall survival 52% (p=0.012). Androgen deprivation therapy had an impact on overall survival with a 5-year of 90% and a 10-year of 57% survival rates, in comparison to a group without androgen deprivation therapy that had a significantly lower 5-year overall survival of 79.8% and a 10-year overall survival of 23.8% (p=0.041). In multivariate analysis, total radiation dose remained of significant impact on overall survival (p=0.022) and risk grouping (p=0.026) on biochemically no evidence of disease survival. Regarding toxicity, Grade II and III late genitourinary toxicity was observed in 13 patients (4.3%), and late gastrointestinal toxicity of similar grade affected 12 patients (4%) in the cohort.
Data from this retrospective analysis underscore the highly relevant influence of total dose in contemporary radiation treatment of patients with prostate cancer.
对于中高危前列腺癌患者，放射治疗是一种成熟的手术替代方案。现代技术，如调强放射治疗和容积调强弧形治疗，能够在使周围健康组织受照剂量最小化的同时，精确地增加肿瘤的照射剂量。本分析的目的是评估两种不同放射治疗方案（高剂量与低剂量）对所有风险类别的前列腺癌患者的安全性和疗效。
2015年至2021年间，该机构共有300例连续性局限性前列腺腺癌患者接受了调强放射治疗和容积调强弧形治疗。研究终点包括总生存期、前列腺癌特异性总生存期、无转移生存期、生化无疾病证据生存率以及急性和长期毒性作用。通过对数秩检验和多变量Cox分析评估患者和治疗相关参数的影响，这些参数包括风险分层（低和中危与高危）、放射治疗剂量水平（<76 Gy与≥76 Gy）、放射治疗持续时间（≤51天与>51天）、是否进行选择性淋巴结照射以及是否使用同期雄激素剥夺治疗。
5年和10年时的总生存期、前列腺癌特异性总生存期、无转移生存期和生化无疾病证据生存率分别为88%、96%、94%、92%以及56%、76%、90%、75%。单因素分析确定了总剂量和雄激素剥夺治疗有显著影响。总放射剂量≥76 Gy的患者5年和10年的总生存率分别为92%和59%，而总剂量<76 Gy的患者5年总生存率为8
