目的:报告我们以前使用立体定向身体放射治疗(SBRT)治疗前列腺癌的最新经验,通过更新的国家综合癌症网络(NCCN)2.2014版对风险进行分层,报告社区医院环境中的疗效和毒性.
方法:从2007年到2012年,142例局限性前列腺癌患者使用射波刀进行SBRT治疗。NCCN指南2.2014版分析的风险组包括非常低(20%),低(23%),中间(35%),高风险(22%)。为了进一步探索群体异质性并遵守新的指导方针,我们根据存在多少个中间风险因素将我们先前的中间风险组分为有利的中间风险组和不利的中间风险组(一个与>一)。根据NCCN指南2.2014版,将不利的中间组与高风险组结合进行进一步分析。在多年的治疗中使用了各种剂量水平,并被归类为低剂量(35Gy,n=5或36.25Gy,n=107)和高剂量(37.5Gy,n=30)。所有处理均以五个部分递送。使用放射治疗肿瘤组标准评估毒性。
结果:在极低的情况下,五年精算无生化衰竭(FFBF)为100、91.7、95.2、90.0和86.7%,低,中危和高危患者,分别。Gleason评分(GS)≥8的患者在5年FFBF与7vs.5/6(p=0.03)和低高剂量(p=0.05)。T-stage,预处理PSA,年龄,风险分层组,ADT的使用不影响5年FFBF。多因素分析显示,GS和剂量是5年FFBF的最大预测因素。
结论:我们使用SBRT治疗局部前列腺癌的经验表明,与文献中报道的IMRT结果相当,疗效和毒性良好。GS仍然是治疗前最重要的预后预测因子。
OBJECTIVE: To report an update of our previous experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer, risk stratified by the updated National Comprehensive Cancer Network (NCCN) version 2.2014, reporting efficacy and toxicity in a community hospital setting.
METHODS: From 2007 to 2012, 142 localized prostate cancer patients were treated with SBRT using
CyberKnife. NCCN
guidelines Version 2.2014 risk groups analyzed included very low (20%), low (23%), intermediate (35%), and high (22%) risk. To further explore group heterogeneity and to comply with new
guidelines, we separated our prior intermediate risk group into favorable intermediate and unfavorable intermediate groups depending on how many intermediate risk factors were present (one vs. > one). The unfavorable intermediate group was further analyzed in combination with the high risk group as per NCCN
guidelines Version 2.2014. Various dose levels were used over the years of treatment, and have been categorized into low dose (35 Gy, n = 5 or 36.25 Gy, n = 107) and high dose (37.5 Gy, n = 30). All treatments were delivered in five fractions. Toxicity was assessed using radiation therapy oncology group criteria.
RESULTS: Five-year actuarial freedom from biochemical failure (FFBF) was 100, 91.7, 95.2, 90.0, and 86.7% for very low, low, intermediate and high risk patients, respectively. A significant difference in 5 year FFBF was noted for patients with Gleason score (GS) ≥8 vs. 7 vs. 5/6 (p = 0.03) and low vs. high dose (p = 0.05). T-stage, pretreatment PSA, age, risk stratification group, and use of ADT did not affect 5-year FFBF. Multivariate analysis revealed GS and dose to be the most predictive factors for 5-year FFBF.
CONCLUSIONS: Our experience with SBRT for the primary treatment of localized prostate cancer demonstrates favorable efficacy and toxicity comparable to the results reported for IMRT in literature. GS remains the single most important pretreatment predictor of outcome.