目的:前列腺癌是男性中最常见的癌症,放疗大分割方案已成为局部阶段的标准治疗方法。但仍必须证明剂量递增不会增加急性和晚期泌尿生殖系统或胃肠道毒性的风险.
方法:研究人群包括2016年2月至2018年3月在居里机构接受外部辐射治疗的所有局限性前列腺腺癌患者,使用图像引导的适形强度调制技术,在计划目标体积中2.5Gy的30个分数中,总剂量为75Gy,包括前列腺和精囊,近端可以与46Gy的预防性淋巴结放射疗法配对,分为23个部分,同时进行整合增强。
结果:共纳入166例患者。其中,68.6%是不利的中等或(非常)高风险。中位年龄和随访时间分别为71.4岁和3.96岁。149例患者接受预防性淋巴结放疗(89.8%)。131例患者接受了激素治疗(78.9%)。放疗期间2级或以上的生殖器-尿液毒性事件,6个月时,1年和5年分别为36.7%,8.8%,3.1%和4.7%。两名患者在5岁时出现晚期4级毒性(1.6%)。放疗期间2级胃肠道毒性事件,6个月,1年和5年分别为15.1%,1.9%,14.6%和9.3%。其中,8例患者出现3级毒性(6.2%).没有4级毒性。分析没有发现任何毒性预测因素。5年总体来说,无进展,生存率分别为82.4%,85.7%,和93.3%。发现血清前列腺特异性抗原浓度和心血管危险因素是总生存期恶化的预测因素(两者P=0.0028)。
结论:我们的中度小分割剂量递增方案用于局部前列腺癌的外放疗耐受性良好。在没有增加晚期毒性的情况下,对长期复发模式的分析将有助于确定这种剂量递增对局部和远处复发的益处.
OBJECTIVE: Prostate cancer is the most frequent cancer among men and radiotherapy hypofractionation regimens have become standard treatments for the localized stages, but the absence of increased risk of acute and late genitourinary or gastrointestinal toxicity of the dose escalation still must be demonstrated.
METHODS: The study population included all patients with localized prostatic adenocarcinoma treated at the institut Curie from February 2016 to March 2018 by external radiation delivered by a linear accelerator using an image-guided conformal intensity modulation technique at a total dose of 75Gy in 30 fractions of 2.5Gy in the planning target volume that included the prostate and the proximal seminal vesicles, and could be paired with a prophylactic lymph node radiotherapy at 46Gy in 23 fractions with simultaneous integrated boost.
RESULTS: A total of 166 patients were included. Among them, 68.6% were unfavourable intermediate or (very) high risk. The median age and follow-up were 71.4years and 3.96years. One hundred and forty-nine patients received prophylactic lymph node radiotherapy (89.8%). One hundred and thirty-one patients received hormonotherapy (78.9%). Genito-urinary toxicity events of grades 2 or above during radiotherapy, at 6months, 1year and 5years were respectively 36.7%, 8.8%, 3.1% and 4.7%. Two patients had late grade 4 toxicity at 5years (1.6%). Grade 2 gastrointestinal toxicity events during radiotherapy, 6months, 1year and 5years were respectively 15.1%, 1.9%, 14.6% and 9.3%. Of these, eight patients had grade 3 toxicity (6.2%). There was no grade 4 toxicity. Analyses did not reveal any predictive factor for toxicity. The 5-year overall, progression-free, and specific survival rates were respectively 82.4%, 85.7%, and 93.3%. Serum prostate specific antigen concentration and cardiovascular risk factors were found to be predictive factors of deterioration in overall survival (P=0.0028 for both).
CONCLUSIONS: External radiotherapy for localized prostatic cancer with our moderately hypofractionated dose escalation regimen is well tolerated. In the absence of increased late toxicity, the analysis of the modes of long-term relapses will be interesting to determine the benefit of this dose escalation on local and distant relapses.