Low incidence of late recurrence in patients with intermediate-risk prostate cancer treated by intensity-modulated radiation therapy plus short-term androgen deprivation therapy
Low incidence of late recurrence in patients with intermediate-risk prostate cancer treated by intensity-modulated radiation therapy plus short-term androgen deprivation therapy
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DOI：
10.1007/s10147-019-01596-7
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发表时间：
2020-04-01
影响因子：
3.3
通讯作者：
Mizowaki, Takashi
中科院分区：
文献类型：
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作者：
Aizawa, Rihito;Takayama, Kenji;Mizowaki, Takashi
目的评价调强放射治疗(IMRT)联合短期新辅助雄激素剥夺治疗(ADT)治疗中危前列腺癌(PCa)的远期疗效。资料与方法对2000年9月至2010年11月在我所接受调强放射治疗的IR-PCa患者进行回顾性分析。治疗包括调强放射治疗(70~78Gy35~39次)和6个月的新辅助ADT。当前列腺特异性抗原水平达到4.0 ng/mL时，开始挽救ADT。结果共分析了106例连续的IR-PCa患者(中位年龄：70岁)。中位随访期为8.0年。5年总生存率、PCa特异性生存率、生化失败率和临床失败率分别为99.0%、100.0%、6.8%和1.9%，10年后分别为89.1%、100.0%、11.3%和2.9%。晚期复发3例(2.8%)。泌尿生殖系统(GU)和胃肠道(GI)毒性(2/3级)5年累计发生率分别为10.5%和5.8%，10年后分别为14.7%和5.8%。无1例患者出现4/5 GU毒性或3-5 GI毒性。结论在IR-PCa患者中，78GyIMRT联合短期新辅助ADT治疗可获得良好的长期无病预后和可接受的发病率。此外，晚期复发率很低。有必要进行进一步的调查以证实我们的发现。
Objectives This study evaluated the long-term outcomes of intensity-modulated radiation therapy (IMRT) combined with short-term neoadjuvant androgen deprivation therapy (ADT) in patients with intermediate-risk (IR) prostate cancer (PCa). Materials and methods Patients with IR PCa treated with IMRT at our institution between September 2000 and November 2010 were analyzed retrospectively. The treatment consisted of IMRT (70-78 Gy in 35-39 fractions) combined with 6 months of neoadjuvant ADT. Salvage ADT was initiated when the prostate-specific antigen level was > 4.0 ng/mL Results In total, 106 consecutive patients with IR PCa (median age: 70 years old) were analyzed. The median follow-up period was 8.0 years. The overall survival, PCa-specific survival, biochemical failure, and clinical failure rates were 99.0%, 100.0%, 6.8%, and 1.9% at 5 years and 89.1%, 100.0%, 11.3%, and 2.9% at 10 years, respectively. Late recurrence (> 5 years) was observed in three cases (2.8%). The cumulative incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicities (grade 2/3) were 10.5% and 5.8% at 5 years, and 14.7% and 5.8% at 10 years, respectively. No patient developed grade 4/5 GU toxicities or grade 3-5 GI toxicities. Conclusion IMRT at a dose up to 78 Gy combined with short-term neoadjuvant ADT resulted in excellent long-term disease-free outcomes with acceptable morbidities among patients with IR PCa. In addition, the incidence of late recurrence was very low. Further investigation is warranted to confirm our findings.