高危前列腺癌的风险适应性强化治疗：辐射剂量的作用有多重要？
Risk-adapted intensification therapy in high-risk prostate cancer: how relevant is the role of radiation dose.
作者信息
Zapatero A, Roch M, Martín de Vidales C, Castro P, Montes N, Cruz Conde A, Fernández-Banda Laura, Zaragoza Laura, Carroceda Sara, García Vicente F
机构信息
Radiation Oncology Department, Hospital Universitario de La Princesa, Health Research Institute IIS-IP, Diego de León 62, 28006, Madrid, Spain.
Medical Physics, University Hospital La Princesa, Health Research Institute, Madrid, Spain.
出版信息
Radiat Oncol. 2025 Jun 15;20(1):102. doi: 10.1186/s13014-025-02665-0.
BACKGROUND/PURPOSE: Dose escalation has demonstrated a significant improvement in biochemical recurrence in high-risk prostate cancer (HRPCa). We evaluated the impact on overall survival (OS) of dose intensification with external beam radiation therapy (EBRT) in a cohort of HRPCa patients treated in a single institution.
METHODS AND MATERIALS
Between January 1997 and January 2024, a total of 1451 consecutive localized PCa patients were treated with primary EBRT alone as part of a prospective institutional program for risk-adapted dose-intensification radiotherapy. For the present analysis, we specifically selected a cohort of 424 consecutive HRPCa patients with a minimum follow-up (FU) of 5 years. The median RT dose was 79.2 Gy (interquartile range [IQR] 74.9-80.3). Short and long-term hormones were administered in 56 (13%) and 350 (83%) of patients respectively. Kaplan-Meier curves were used to calculate overall survival (OS). Cumulative incidence of distant metastasis (DM), and cause specific survival (CSS) were estimated using competing risk regression.
RESULTS
Median patient age was 69 years (IQR 65-72) and median FU was 118 months (IQR 88.0-135.0). At the time of analysis, 54 of 424 patients (13%) had died. The leading cause of death was cardiovascular disease in 16/54 patients (4%), followed by PCa in 15 patients (3%). At 10 and 15 years, the KM estimated OS rates were 91% (95% CI 87-93) and 71% (95% CI 61-79), respectively. The corresponding rates for MFS were 87% (95% CI 83-90) and 60% (95% CI 49-68), and for CSS were 97% (95% CI 95-99) and 90% (95% CI 49-81), respectively. In multivariate analysis, when adjusted for patient age, T stage, Gleason/ISUP group, PSA and length of hormone-therapy, higher radiation dose remained significantly associated with an improved OS (HR 0.89; 95% CI 0.84-0.94), MFS (HR 0.94; 95% CI 0.90-0.98) and CSS (HR 0.89; 95% CI 0.84-0.94).
CONCLUSIONS
The present study confirms that radiation dose intensification is paramount in the treatment of HRPCa with independence of duration of ADT.
背景/目的：剂量递增已证明可显著改善高危前列腺癌（HRPCa）的生化复发情况。我们评估了在单一机构接受治疗的一组HRPCa患者中，外照射放疗（EBRT）剂量强化对总生存期（OS）的影响。
方法和材料
1997年1月至2024年1月期间，共有1451例连续的局限性前列腺癌患者接受了单纯原发性EBRT治疗，这是一项针对风险适应性剂量强化放疗的前瞻性机构项目的一部分。在本分析中，我们特意挑选了一组424例连续的HRPCa患者，其最短随访时间为5年。放疗的中位剂量为79.2 Gy（四分位间距[IQR] 74.9 - 80.3）。分别有56例（13%）和350例（83%）患者接受了短期和长期激素治疗。采用Kaplan-Meier曲线计算总生存期（OS）。使用竞争风险回归估计远处转移（DM）的累积发生率和特定病因生存期（CSS）。
结果
患者的中位年龄为69岁（IQR 65 - 72），中位随访时间为118个月（IQR 88.0 - 135.0）。在分析时，424例患者中有54例（13%）死亡。主要死亡原因是心血管疾病，共16/54例患者（4%），其次是前列腺癌，共15例患者（3%）。在10年和15年时，Kaplan-Meier估计的总生存率分别为91%（95% CI 87 - 93）和71%（95% CI 61 - 79）。无转移生存期（MFS）的相应比率分别为87%（CI 83 - 90）和60%（95% CI 49 - 68），特定病因生存期（CSS）的相应比率分别为97%（95% CI 95 - 99）和90%（95% CI 49 - 81）。在多变量分析中，在对患者年龄、T分期、Gleason/ISUP组、前列腺特异性抗原（PSA）和激素治疗时长进行校正后，较高的放疗剂量仍与总生存期（HR 0.89；95% CI 0.84 - 0.94）、无转移生存期（HR 0.94；95% CI 0.90 - 0.98）和特定病因生存期（HR 0.89；95% CI 0.84 - 0.94）的改善显著相关。
结论
本研究证实，在HRPCa的治疗中，放疗剂量强化至关重要，且与雄激素剥夺治疗（ADT）的持续时间无关
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