Improved Clinical Outcomes With High-Dose Image Guided Radiotherapy Compared With Non-IGRT for the Treatment of Clinically Localized Prostate Cancer
Improved Clinical Outcomes With High-Dose Image Guided Radiotherapy Compared With Non-IGRT for the Treatment of Clinically Localized Prostate Cancer
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DOI：
10.1016/j.ijrobp.2011.11.047
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发表时间：
2012-09-01
影响因子：
7
通讯作者：
Hunt, Margie
中科院分区：
文献类型：
--
作者：
Zelefsky, Michael J.;Kollmeier, Marisa;Hunt, Margie
目的：比较临床局限性前列腺癌接受高剂量图像引导放疗 (IGRT) 和高剂量调强放疗 (IMRT) 治疗的患者的毒性特征和生化肿瘤控制结果。 材料和方法：2008 年至 2009 年间，186 名前列腺癌患者接受 IGRT 治疗，剂量为 86.4 Gy，并根据植入前列腺的千伏成像每日校正靶位置基准标记。将该组患者与 2006 年至 2007 年间接受相同处方剂量的 IMRT 治疗但未植入基准标记（非 IGRT）的 190 名类似患者进行回顾性比较。中位随访时间为 2.8 年（范围为 2-6 年）。 结果：与非 IGRT 患者相比，IGRT 患者的晚期尿毒性显着降低。 IGRT 和非 IGRT 队列的 3 年 2 级及以上泌尿系统毒性的可能性分别为 10.4% 和 20.0% (p = 0.02)。确定 2 级或更高级别晚期尿路毒性预测因素的多变量分析表明，除了基线国际前列腺症状评分之外，与非 IGRT 相比，IGRT 与显着较少的晚期尿路毒性相关。两个治疗组的 2 级及以上直肠毒性发生率均较低（分别为 1.0% 和 1.6%；p = 0.81）。对于低风险和中风险患者，接受 IGRT 和非 IGRT 治疗时，前列腺特异性抗原无复发生存结果没有差异。对于高危患者，与非 IGRT 治疗的患者相比，接受 IGRT 治疗的患者在 3 年时观察到显着改善。结论：与高剂量 IMRT 相比，IGRT 与高危患者生化肿瘤控制的改善以及较低的晚期尿毒性发生率相关。这些数据表明，对于确定性放射治疗，基准标记的放置和目标定位的日常跟踪可能代表了治疗前列腺癌的外照射放射治疗的首选模式。 (C) 2012 爱思唯尔公司。
Purpose: To compare toxicity profiles and biochemical tumor control outcomes between patients treated with high-dose image-guided radiotherapy (IGRT) and high-dose intensity-modulated radiotherapy (IMRT) for clinically localized prostate cancer.Materials and Methods: Between 2008 and 2009, 186 patients with prostate cancer were treated with IGRT to a dose of 86.4 Gy with daily correction of the target position based on kilovoltage imaging of implanted prostatic fiducial markers. This group of patients was retrospectively compared with a similar cohort of 190 patients who were treated between 2006 and 2007 with IMRT to the same prescription dose without, however, implanted fiducial markers in place (non-IGRT). The median follow-up time was 2.8 years (range, 2-6 years).Results: A significant reduction in late urinary toxicity was observed for IGRT patients compared with the non-IGRT patients. The 3-year likelihood of grade 2 and higher urinary toxicity for the IGRT and non-IGRT cohorts were 10.4% and 20.0%, respectively (p = 0.02). Multivariate analysis identifying predictors for grade 2 or higher late urinary toxicity demonstrated that, in addition to the baseline Internatinoal Prostate Symptom Score, IGRT was associated with significantly less late urinary toxicity compared with non-IGRT. The incidence of grade 2 and higher rectal toxicity was low for both treatment groups (1.0% and 1.6%, respectively; p = 0.81). No differences in prostate-specific antigen relapse-free survival outcomes were observed for low-and intermediate-risk patients when treated with IGRT and non-IGRT. For high-risk patients, a significant improvement was observed at 3 years for patients treated with IGRT compared with non-IGRT.Conclusions: IGRT is associated with an improvement in biochemical tumor control among high-risk patients and a lower rate of late urinary toxicity compared with high-dose IMRT. These data suggest that, for definitive radiotherapy, the placement of fiducial markers and daily tracking of target positioning may represent the preferred mode of external-beam radiotherapy delivery for the treatment of prostate cancer. (C) 2012 Elsevier Inc.