Stereotactic ablative radiotherapy in the treatment of low and intermediate risk prostate cancer: Is there an optimal dose?
Stereotactic ablative radiotherapy in the treatment of low and intermediate risk prostate cancer: Is there an optimal dose?
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DOI：
10.1016/j.radonc.2017.03.006
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发表时间：
2017-06-01
影响因子：
5.7
通讯作者：
Loblaw, Andrew
中科院分区：
文献类型：
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作者：
Helou, Joelle;D'Alimonte, Laura;Loblaw, Andrew
目的：为探讨立体定向消融放射治疗（SABR）剂量与前列腺癌术后3年PSA（3 y）的关系及晚期泌尿生殖系统（GU）毒性的预测因素，材料与方法：在我院进行了3个SABR的前瞻性试验：1）35戈伊/5次/29 d; 2）40戈伊/5次/29 d;（3）40戈伊/5次/11天或29天。PSA（3年）作为连续变量进行分析。毒性定义为最严重的新毒性，并使用放射治疗肿瘤组（RTOG）晚期发病率方案进行评估。进行单变量和多变量回归分析，以评估剂量和PSA（3年）之间的关联，并探讨晚期2级+ GU toxicity.Results的预测因素：中位数PSA 3年为0.64（四分位数范围（IQR）：0.41-1.12）和0.27（IQR：0.12-0.55）ng/mL的患者治疗与35和40戈伊分别。在多变量分析中，40戈伊剂量是较低PSA（3年）的独立预测因子（p < 0.001）。剂量40戈伊（比值比（OR）：16.69，95%CI：5.78，48.20，p < 0.001）和较高的国际前列腺症状评分（OR：1.01，95%CI：1.04，1.16，p = 0.001）预测的晚期2级+ GU毒性。该分析表明，较高的SABR剂量与较低的PSA（3年）相关。应进一步研究允许安全SABR剂量递增的策略。(C)2017爱思唯尔B. V.保留所有权利。
Purpose: To investigate if stereotactic ablative radiotherapy (SABR) dose is associated with PSA at 3 years (PSA(3y)) in the treatment of localized prostate cancer and to explore predictors of late genitourinary (GU) toxicity.Materials and methods: Three prospective trials of SABR were undertaken at our institution: 1) 35 Gy/5 fractions/29 days; 2) 40 Gy/5 fractions/29 days; 3) 40 Gy/5 fractions/11 or 29 days. PSA(3y) was analyzed as a continuous variable. Toxicity was defined as the worst new toxicity and assessed using the radiation therapy oncology group (RTOG) late morbidity scheme. Univariate and multivariable regression analyses were conducted to assess the association between dose and PSA(3y), and to explore predictors of late grade 2+ GU toxicity.Results: Median PSA3y was 0.64 (intraquartile range (IQR): 0.41-1.12) and 0.27 (IQR: 0.12-0.55) ng/mL for patients treated with 35 and 40 Gy respectively. A dose of 40 Gy was an independent predictor of lower PSA(3y) on multivariable analysis (p < 0.001). Dose of 40 Gy (odds ratio (OR): 16.69, 95%CI: 5.78, 48.20, p < 0.001) and higher International Prostate Symptom Score (OR: 1.01, 95%CI: 1.04, 1.16, p = 0.001) predicted for late grade 2+ GU toxicity on multivariable logistic regression.Conclusions: This analysis suggests that higher SABR dose is associated with lower PSA(3y). Strategies to allow safe SABR dose escalation should be further investigated. (C) 2017 Elsevier B.V. All rights reserved.