Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence.
Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence.
复制标题
DOI：
10.1186/1748-717x-9-135
复制
发表时间：
2014-06-12
期刊：
影响因子：
--
通讯作者：
Ost P
中科院分区：
文献类型：
--
作者：
Decaestecker K;De Meerleer G;Lambert B;Delrue L;Fonteyne V;Claeys T;De Vos F;Huysse W;Hautekiet A;Maes G;Ost P
评估前列腺癌 (PCa) 复发时诊断为寡转移性疾病并接受立体定向放射治疗 (SBRT) 的患者的结果。通过正电子发射断层扫描 - 计算机断层扫描诊断出最多 3 个同步转移（骨和/或淋巴结）的非去势患者，在局部治疗后生化复发后，接受（重复）SBRT 治疗，剂量为 50 Gy（分 10 次）或 30 Gy（分 3 次）。主要终点是无雄激素剥夺治疗生存期 (ADT-FS)，定义为 SBRT 第一天和 ADT 开始之间的时间间隔。如果在随访期间检测到超过 3 个转移灶，即使患者仍无症状，也会开始 ADT。次要终点是局部控制、无进展生存期（PFS）和毒性。使用不良事件通用术语标准对毒性进行评分。从 SBRT 开始的中位随访时间为 2 年，我们治疗了 50 名患者，其中有 70 个转移灶，局部控制率为 100%。主要转移部位为淋巴结（54%）、骨（44%）和内脏（2%）。中位 PFS 为 19 个月（95% CI：13-25 个月），75% 的复发患者有 ≤ 3 个转移灶。分别有 19 名和 6 名患者接受了第 2 次和第 3 次 SBRT 疗程。这导致 ADT-FS 的中位数为 25 个月（20-30 个月）。在单变量分析中，只有较短的 PSA 倍增时间才是 PFS（HR：0.90，95% CI：0.82 – 0.99）和 ADT-FS（HR：0.83；95% CI：0.71 – 0.97）的显着预测因素。 10 例患者（20%）在治疗后出现毒性反应，其中 7 例为 I 级，3 例为 II 级。针对寡转移性前列腺癌的重复 SBRT 可将姑息性雄激素剥夺疗法推迟 2 年，且无 III 级毒性。
To assess the outcome of prostate cancer (PCa) patients diagnosed with oligometastatic disease at recurrence and treated with stereotactic body radiotherapy (SBRT). Non-castrate patients with up to 3 synchronous metastases (bone and/or lymph nodes) diagnosed on positron emission tomography - computed tomography, following biochemical recurrence after local curative treatment, were treated with (repeated) SBRT to a dose of 50 Gy in 10 fractions or 30 Gy in 3 fractions. Androgen deprivation therapy-free survival (ADT-FS) defined as the time interval between the first day of SBRT and the initiation of ADT was the primary endpoint. ADT was initiated if more than 3 metastases were detected during follow-up even when patients were still asymptomatic. Secondary endpoints were local control, progression free survival (PFS) and toxicity. Toxicity was scored using the Common Terminology Criteria for Adverse Events. With a median follow-up from time of SBRT of 2 years, we treated 50 patients with 70 metastatic lesions with a local control rate of 100%. The primary involved metastatic sites were lymph nodes (54%), bone (44%), and viscera (2%). The median PFS was 19 mo (95% CI: 13–25 mo) with 75% of recurring patients having ≤3 metastases. A 2nd and 3rd course of SBRT was delivered in 19 and 6 patients respectively. This results in a median ADT-FS of 25 months (20–30 mo). On univariate analysis, only a short PSA doubling time was a significant predictor for both PFS (HR: 0.90, 95% CI: 0.82 – 0.99) and ADT-FS (HR: 0.83; 95% CI: 0.71 – 0.97). Ten patients (20%) developed toxicity following treatment, which was classified as grade I in 7 and grade II in 3 patients. Repeated SBRT for oligometastatic prostate cancer postpones palliative androgen deprivation therapy with 2 years without grade III toxicity.