Nahaji István, Kocsis Zsuzsa S, Kovács Andrea, Varga Levente, Gesztesi László, Jorgo Kliton, Takácsi-Nagy Zoltán, Polgár Csaba, Ágoston Péter
National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.
National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary.
Clin Transl Radiat Oncol. 2025 Apr 11;53:100960. doi: 10.1016/j.ctro.2025.100960. eCollection 2025 Jul.
In the treatment of node-negative, non-metastatic high-risk (HR) and very high-risk (VHR) prostate cancer, the necessity of elective pelvic irradiation is controversial. According to our in-house treatment protocol - elective pelvic irradiation is generally omitted for HR and VHR patients over the age of 70 or those in poor general health due to its toxicity.
To retrospectively examine the outcome for HR and VHR prostate cancer patients treated with elective whole pelvic radiotherapy (WPRT) versus prostate-only radiotherapy (PORT).
The study included 434 patients treated with definitive radiotherapy, 203 patients received PORT (HR: 127, VHR: 76) and 231 WPRT (HR: 113, VHR: 118) with a boost to the prostate. Patients also received 2-3 years of androgen deprivation. Patients' average age who received PORT vs. WPRT was 73.9 ± 4.3 years vs. 66.4 ± 5.4 years respectively. An inverse propensity score weighting method was utilized to create homogeneous WPRT and PORT treatment groups that are balanced for T stage, PSA, and Gleason score, but not for age. The survival outcomes for HR and VHR subgroups were examined depending on whether they received WPRT or PORT. Biochemical- (BRFS), local- (LRFS) and regional relapse-free survival (RRFS), distant metastasis-free- (DMFS), disease-free- (DFS), failure-free- (FFS), and overall survival (OS) were compared using the Kaplan -Meier method and Cox regression analysis.
The median follow-up time was 76 months (3-134 months). In the VHR subgroup five-year outcomes showed a significant advantage for patients receiving WPRT vs. PORT in BRFS (82.2 % vs. 73 %; p = 0.028), in DMFS (87.5 % vs. 73.6 %; p = 0.025), in DFS (86.1 % vs. 70.5 %; p = 0.012), and in FFS (82.3 % vs. 68.9 %; p = 0.005), respectively. The OS (92.8 % vs. 81.8 %; p = 0.056) showed a trend favoring the WPRT group. There was no significant difference between WPRT vs. PORT in LRFS (95.8 % vs. 96.4 %; p = 0.763) and RRFS (95.8 % vs. 89.9 %; p = 0.099). On the contrary, in the HR group, no significant survival differences were observed between WPRT vs. PORT groups: BRFS 93.0 % vs. 93.3 % (p = 0.978), LRFS 99.0 % vs. 100 % (p = 0.120), RRFS 98.2 % vs. 95.1 % (p = 0.813), DMFS 93.5 % vs. 95.5 % (p = 0.793), DFS 91.7 % vs. 92.9 % (p = 0.691), FFS 89.5 % vs. 90.9 % (p = 0.853), OS 91.0 % vs. 87.7 % (p = 0.407).
Based on our retrospective data elective pelvic irradiation can be omitted in HR patients, especially over the age of 70. For VHR patients, elective pelvic irradiation should be considered even for the subgroup of elderly patients.
在治疗淋巴结阴性、无转移的高危（HR）和极高危（VHR）前列腺癌时，选择性盆腔照射的必要性存在争议。根据我们内部的治疗方案——由于其毒性，对于70岁以上或总体健康状况较差的HR和VHR患者，通常省略选择性盆腔照射。
回顾性研究接受选择性全盆腔放疗（WPRT）与仅前列腺放疗（PORT）的HR和VHR前列腺癌患者的治疗结果。
该研究纳入了434例接受根治性放疗的患者，203例患者接受PORT（HR：127例，VHR：76例），231例接受WPRT（HR：113例，VHR：118例）并对前列腺进行追加放疗。患者还接受了2 - 3年的雄激素剥夺治疗。接受PORT与WPRT的患者平均年龄分别为73.9±4.3岁和66.4±5.4岁。采用逆倾向评分加权方法创建了在T分期、前列腺特异性抗原（PSA）和 Gleason评分方面均衡但年龄不均衡的WPRT和PORT同质治疗组。根据HR和VHR亚组接受WPRT或PORT的情况检查生存结果。使用Kaplan - Meier方法和Cox回归分析比较生化无复发生存率（BRFS）、局部无复发生存率（LRFS）、区域无复发生存率（RRFS）、远处转移无复发生存率（DMFS）、无病生存率（DFS）、无失败生存率（FFS）和总生存率（OS）。
中位随访时间为76个月（3 - 134个月）。在VHR亚组中，五年结果显示接受WPRT的患者在BRFS（82.2%对73%；p = 0.028）、DMFS（87.5%对73.6%；p = 0.0
