Five-Year Outcomes from 3 Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer
Five-Year Outcomes from 3 Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer
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DOI：
10.1016/j.ijrobp.2013.11.007
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发表时间：
2014-03-01
影响因子：
7
通讯作者：
Henderson, Randal H.
中科院分区：
文献类型：
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作者：
Mendenhall, Nancy P.;Hoppe, Bradford S.;Henderson, Randal H.
目的：报告3项前列腺癌影像引导质子治疗前瞻性试验的5年临床结果。
方法和材料：共有211例前列腺癌患者（89例低危，82例中危，40例高危）在机构审查委员会批准的试验中接受治疗。低危疾病采用39次分割共78钴灰色当量（CGE），中危疾病采用78 - 82 CGE，高危疾病采用78 CGE并同时使用多西他赛治疗，随后进行雄激素剥夺治疗。毒性根据《不良事件通用术语标准》（CTCAE）第3.0版进行分级。中位随访时间为5.2年。
结果：低危、中危和高危患者的5年生化无疾病进展率和临床无疾病进展率分别为99%、99%和76%。第3.0版（或第4.0版）晚期CTCAE的3级胃肠和泌尿系统毒性的5年精算发生率分别为1.0%（0.5%）和5.4%（1.0%）。低危、中危和高危患者治疗前的中位评分以及治疗后>4年的国际前列腺症状评分分别为8和7、6和6以及9和8。在肠道、尿路刺激和/或梗阻以及尿失禁方面，治疗前的中位总结评分与治疗后>4年的扩展前列腺癌指数综合评分之间无显著变化。
结论：影像引导质子治疗的5年临床结果包括极高的疗效、医生评估的极小毒性以及出色的患者报告结果。需要进一步随访和更多的患者经验来证实这些良好的结果。（C）2014爱思唯尔公司
Purpose: To report 5-year clinical outcomes of 3 prospective trials of image-guided proton therapy for prostate cancer.Methods and Materials: A total of 211 prostate cancer patients (89 low-risk, 82 intermediaterisk, and 40 high-risk) were treated in institutional review board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, 78 to 82 CGE for intermediaterisk disease, and 78 CGE with concomitant docetaxel therapy followed by androgen deprivation therapy for high-risk disease. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Median follow-up was 5.2 years.Results: Five-year rates of biochemical and clinical freedom from disease progression were 99%, 99%, and 76% in low-, intermediate-, and high-risk patients, respectively. Actuarial 5-year rates of late CTCAE, version 3.0 (or version 4.0) grade 3 gastrointestinal and urologic toxicity were 1.0% (0.5%) and 5.4% (1.0%), respectively. Median pretreatment scores and International Prostate Symptom Scores at >4 years posttreatment were 8 and 7, 6 and 6, and 9 and 8, respectively, among the low-, intermediate-, and high-risk patients. There were no significant changes between median pretreatment summary scores and Expanded Prostate Cancer Index Composite scores at >4 years for bowel, urinary irritative and/or obstructive, and urinary continence.Conclusions: Five-year clinical outcomes with image-guided proton therapy included extremely high efficacy, minimal physician-assessed toxicity, and excellent patient-reported outcomes. Further follow-up and a larger patient experience are necessary to confirm these favorable outcomes. (C) 2014 Elsevier Inc.