背景:我们报告了经会阴超声图像引导放疗(TPUS-IGRT)治疗局限性前列腺癌(LPCa)的回顾性分析结果。
方法:共有124例患者(中位年龄:74岁,46-84y)与接受TPUS-IGRT(清晰度自动扫描系统;CAS,Elekta;斯德哥尔摩,瑞典)在2016年4月至2021年10月期间纳入治疗性/激素诱导后。按风险划分的患者数量(国家综合癌症网络2019年)为7、25、42和50(LR),良好的中间体(良好的IR),中间差(IR差),和高(HR)/非常高(VHR),分别。95例患者接受了新辅助激素治疗。大多数情况下,直肠的计划目标容积裕度设置为3mm,上/下5-7毫米,前/右/左5mm。主要规定剂量为74Gy(LR),76Gy(良好的红外光谱),和76-78Gy(IR差或以上)。CAS配备了实时前列腺帧内监测(RTPIFM)系统。当检测到2-3毫米或更大的位移时,照射暂停,患者被置于前列腺恢复/再矫正的待命状态。在进行RTPIFM的85例患者的3135个部分中,1008个级分(32.1%)在开始照射后重新校正至少一次。
结果:共有123例患者完成了放疗疗程。5年总生存率为95.9%。LR的5年生物学前列腺特异性抗原无复发生存率(bPFS)为100%,中间IR为92.9%,HR/VHR(凤凰法)为93.2%。对于泌尿生殖系统(GU),2级的5年晚期毒性率为7.4%,对于胃肠道(GI)器官为6.5%。比较≤76Gy组和78Gy组的GU和GI器官,两组中78Gy组的发病率均较高.
结论:这些结果表明TPUS-IGRT具有良好的耐受性,因为bPFS和晚期毒性的发生率几乎与其他来源的图像引导放射治疗报告的相当。
BACKGROUND: We report the results of a retrospective analysis of localized prostate cancer (LPCa) treated with transperineal ultrasound image-guided radiotherapy (TPUS-IGRT).
METHODS: A total of 124 patients (median age: 74 y, 46-84 y) with LPCa who underwent TPUS-IGRT (Clarity Autoscan system; CAS, Elekta; Stockholm, Sweden) between April 2016 and October 2021 for curative/after hormone induction were enrolled. The number of patients by risk (National Comprehensive Cancer Network 2019) was 7, 25, 42, and 50 for low (LR), good intermediate (good IR), poor intermediate (poor IR), and high (HR)/very high (VHR), respectively. Ninety-five patients were given neoadjuvant hormonal therapy. The planning target volume margin setting was 3 mm for rectal in most cases, 5-7 mm for superior/inferior, and 5 mm for anterior/right/left. The principle prescribed dose is 74 Gy (LR), 76 Gy (good IR), and 76-78 Gy (poor IR or above). CAS was equipped with a real-time prostate intrafraction monitoring (RTPIFM) system. When a displacement of 2-3 mm or more was detected, irradiation was paused, and the patients were placed on standby for prostate reinstatement/recorrection. Of the 3135 fractions in 85 patients for whom RTPIFM was performed, 1008 fractions (32.1%) were recorrected at least once after starting irradiation.
RESULTS: A total of 123 patients completed the radiotherapy course. The 5-year overall survival rate was 95.9%. The 5-year biological prostate-specific antigen relapse-free survival rate (bPFS) was 100% for LR, 92.9% for intermediate IR, and 93.2% for HR/VHR (Phoenix method). The 5-year late toxicity rate of Grade 2+ was 7.4% for genitourinary (GU) and 6.5% for gastrointestinal (GI) organs. Comparing the ≤ 76 Gy group to the 78 Gy group for both GU and GI organs, the incidence was higher in the 78 Gy group for both groups.
CONCLUSIONS: These results suggest that TPUS-IGRT is well tolerated, as the bPFS and incidence of late toxicity are almost comparable to those reported by other sources of image-guided radiotherapy.