Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience.
Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience.
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DOI：
10.1186/1748-717x-8-58
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发表时间：
2013-03-13
期刊：
影响因子：
--
通讯作者：
Collins SP
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作者：
Chen LN;Suy S;Uhm S;Oermann EK;Ju AW;Chen V;Hanscom HN;Laing S;Kim JS;Lei S;Batipps GP;Kowalczyk K;Bandi G;Pahira J;McGeagh KG;Collins BT;Krishnan P;Dawson NA;Taylor KL;Dritschilo A;Lynch JH;Collins SP
立体定向全身放射治疗(SBRT)提供较少的高剂量放射部分，这可能有利于前列腺癌放射治疗常用的常规低剂量部分的放射生物学。我们报告了我们早期使用SBRT治疗局限性前列腺癌的经验。2008年6月至2010年5月在乔治城大学医院接受SBRT治疗的局限性前列腺癌患者，无论是否使用雄激素剥夺疗法(ADT)，都被纳入这项前瞻性收集于机构数据库的数据的回顾回顾中。治疗使用CyberKnife®，剂量为35Gy或36.25Gy5次。使用菲尼克斯定义对生化控制进行评估。使用CTCAE v.3记录毒性并进行评分。治疗前后采用简明健康状况调查表(SF-12)、美国泌尿外科协会症状评分(AUA)和男性性健康问卷(Shim)进行生活质量评估。晚期尿失禁定义为 ≥ 评分为15分，治疗结束后6个月 ≥ 评分较治疗前增加5分。100名患者(根据D‘Amico分类，37名低风险患者，55名中危患者和8名高危患者)接受了SBRT，其中11名患者接受了ADT。治疗前前列腺特异性抗原(PSA)中位数为6.2 ng/ml(1.9~31.6 ng/ml)，中位随访期为2.3年(1.4~3.5年)。两年后，PSA中位数降至0.49 ng/ml(范围为0.1-1.9 ng/ml)。31%的患者出现良性PSA反弹。高危患者中有一例生化失败，两年内生化无复发存活率为99%。GI和GU毒性 ≥ 2级2年精算发生率分别为1%和31%。中位基线AUA症状评分在1个月时显著增加到11分(p = 0.001)，但在3个月时恢复到基线水平(p = 0.60)。21%的患者在治疗后的头两年经历了晚期一过性尿路症状发作。在治疗前性欲旺盛的患者中，79%的患者在治疗后两年仍保持性欲。临床局限性前列腺癌的SBRT耐受性良好，早期生化反应与其他放射治疗相似。良性PSA反弹很常见。晚期GI和GU毒性发生率与常规分割放射治疗和近距离放射治疗相当。观察到晚期尿路症状红肿，但大多数通过保守治疗得以缓解。在治疗前有效的男性中，很高比例的人在治疗后两年仍然有效。
Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation which may be radiobiologically favorable to conventional low-dose fractions commonly used for prostate cancer radiotherapy. We report our early experience using SBRT for localized prostate cancer. Patients treated with SBRT from June 2008 to May 2010 at Georgetown University Hospital for localized prostate carcinoma, with or without the use of androgen deprivation therapy (ADT), were included in this retrospective review of data that was prospectively collected in an institutional database. Treatment was delivered using the CyberKnife® with doses of 35 Gy or 36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were recorded and scored using the CTCAE v.3. Quality of life was assessed before and after treatment using the Short Form-12 Health Survey (SF-12), the American Urological Association Symptom Score (AUA) and Sexual Health Inventory for Men (SHIM) questionnaires. Late urinary symptom flare was defined as an AUA score ≥ 15 with an increase of ≥ 5 points above baseline six months after the completion of SBRT. One hundred patients (37 low-, 55 intermediate- and 8 high-risk according to the D’Amico classification) at a median age of 69 years (range, 48–90 years) received SBRT, with 11 patients receiving ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.2 ng/ml (range, 1.9-31.6 ng/ml) and the median follow-up was 2.3 years (range, 1.4-3.5 years). At 2 years, median PSA decreased to 0.49 ng/ml (range, 0.1-1.9 ng/ml). Benign PSA bounce occurred in 31% of patients. There was one biochemical failure in a high-risk patient, yielding a two-year actuarial biochemical relapse free survival of 99%. The 2-year actuarial incidence rates of GI and GU toxicity ≥ grade 2 were 1% and 31%, respectively. A median baseline AUA symptom score of 8 significantly increased to 11 at 1 month (p = 0.001), however returned to baseline at 3 months (p = 0.60). Twenty one percent of patients experienced a late transient urinary symptom flare in the first two years following treatment. Of patients who were sexually potent prior to treatment, 79% maintained potency at 2 years post-treatment. SBRT for clinically localized prostate cancer was well tolerated, with an early biochemical response similar to other radiation therapy treatments. Benign PSA bounces were common. Late GI and GU toxicity rates were comparable to conventionally fractionated radiation therapy and brachytherapy. Late urinary symptom flares were observed but the majority resolved with conservative management. A high percentage of men who were potent prior to treatment remained potent two years following treatment.