Management of Isolated Local Failures Following Stereotactic Body Radiation Therapy for Low to Intermediate Risk Prostate Cancer.
Management of Isolated Local Failures Following Stereotactic Body Radiation Therapy for Low to Intermediate Risk Prostate Cancer.
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DOI：
10.3389/fonc.2020.551491
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发表时间：
2020
影响因子：
4.7
通讯作者：
Collins SP
中科院分区：
文献类型：
--
作者：
Aghdam N;Pepin AN;Creswell M;Hsieh K;Smith C;Drescher N;Danner M;Ayoob M;Yung T;Lei S;Kumar D;Collins BT;Lischalk JW;Krishnan P;Suy S;Lynch J;Bandi G;Hankins RA;Collins SP
背景：立体定向全身放射治疗(SBRT)对于中低危前列腺癌患者是一种安全有效的治疗选择。SBRT导致非常低的PSA最低值，继而是高生物有效剂量的交付。关于可挽救的孤立局部故障(ILF)的诊断、确认和管理的研究有限。本研究旨在确定大型单一机构队列中SBRT后ILF的发生率和处理方法。方法：所有在乔治敦大学医院接受SBRT治疗的低危或中危局限性前列腺癌患者均符合本研究条件。使用机器人SBRT进行治疗，剂量为35-36.25Gy5次。在达到长期最低点后，通过多参数MRI和/或PSA水平上升提示的活检来诊断ILF。患者的特征提取自前瞻性机构生活质量试验(IRB 2009-510)。在随后的随访和图表回顾中确定抢救治疗的类型和抢救后的PSA。结果：在2008年12月至2018年8月期间，998名患有中低危前列腺癌的男性符合纳入这项分析的条件。24例患者(低风险，n=5；中等风险，n=19)在MRI(n=19)和/或活检(n=20)中发现前列腺内ILF。治疗前中位PSA为7.55 ng/ml，中位诊断时间为72个月(24~110个月)，中位PSA为2.8 ng/ml(0.7~33 ng/ml)。中位PSA倍增时间为17个月(5~47个月)。13例经病理证实的ILF患者接受了抢救治疗(冷冻治疗12例，HIFU治疗1例)。在接受冷冻治疗的12名患者中，7名患者治疗后PSA为0.1 ng/ml。1名患者发生了尿瘘(3级毒性)。结论：孤立性局部复发在我们的队列中很少见。SBRT后孤立局部故障的诊断和管理继续发展。我们的报告强调了在较低的PSA水平和较长的PSA倍增时间下早期利用MRI和确认性活检的重要性。此外，挽救治疗后检测不到的PSA水平支持早期治疗在ILF中的作用。需要进一步的研究来确定在这一人群中合适的患者选择和抢救方式。
Background: Stereotactic body radiation therapy (SBRT) is a safe and effective treatment option for patients with low to intermediate risk prostate cancer. SBRT results in very low PSA nadirs secondary to the delivery of high biologically effective doses. Studies reporting on the diagnosis, confirmation, and management of salvageable isolated local failures (ILF) are limited. This study aims to determine the incidence and management approach of ILF after SBRT in a large single institution cohort. Method: All patients with low or intermediate risk localized prostate cancer treated with SBRT at Georgetown University Hospital were eligible for this study. Treatment was delivered using robotic SBRT with doses of 35–36.25 Gy in five fractions. ILF were diagnosed using multiparametric MRI and/or biopsy prompted by rising PSA levels after achieving long-term nadir. Patient's characteristics were extracted from a prospective institutional quality of life trial (IRB 2009-510). Type of salvage therapy and post-salvage PSA were determined on subsequent follow-up and chart review. Results: Between December 2008 to August 2018, 998 men with low to intermediate risk prostate cancer were eligible for inclusion in this analysis. Twenty-four patients (low risk, n = 5; intermediate risk, n = 19) were found to have ILF within the prostate on either MRI (n = 19) and/or biopsy (n = 20). Median pre-treatment PSA was 7.55 ng/ml. Median time to diagnosis of ILF was 72 months (24–110 months) with median PSA at the time of ILF of 2.8 ng/ml (0.7–33 ng/ml). Median PSA doubling time was 17 months (5–47 months). Thirteen patients with biopsy proven ILF proceeded with salvage therapy (cryotherapy n = 12, HIFU n = 1). Of 12 patients who underwent cryotherapy, 7 had a post-treatment PSA of <0.1 ng/ml. One patient experienced a urethral-cutaneous fistula (grade 3 toxicity). Conclusion: The incidence of isolated local recurrence is rare in our cohort. Diagnosis and management of isolated local failures post-SBRT continues to evolve. Our report highlights the importance of early utilization of MRI and confirmatory biopsy at relatively low PSA levels and long PSA doubling time. Additionally, undetectable PSA levels after salvage therapy supports the role of early treatment in ILF. Further research is needed to determine appropriate patient selection and salvage modality in this population.
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DOI：
10.1097/coc.0000000000000311
发表时间：
2018-05-01
影响因子：
2.6
作者：
Hegde, John V.;Collins, Sean P.;Kamrava, Mitchell
通讯作者：
Kamrava, Mitchell
影响因子：
2.6
作者：
Finley, David S;Belldegrun, Arie S
通讯作者：
Belldegrun, Arie S
DOI：
10.1016/j.ijrobp.2011.11.030
发表时间：
2012-04-01
影响因子：
7
作者：
Arrayeh, Elnasif;Westphalen, Antonio C.;Coakley, Fergus V.
通讯作者：
Coakley, Fergus V.
影响因子：
13.8
作者：
Kishan, Amar U.;Dang, Audrey;King, Christopher R.
通讯作者：
King, Christopher R.
影响因子：
4.5
作者：
Abreu, Andre Luis de Castro;Bahn, Duke;Ukimura, Osamu
通讯作者：
Ukimura, Osamu