- 期刊
The Prognostic Factors and Short-Term Outcome of Intensity-Modulated Radiotherapy for Patients with Prostatic Adenocarcinoma
強度調控放射線治療於攝護腺癌之預後因子及治療結果
摘要
Purpose: We performed this retrospective analysis to evaluate prognostic factors and short-term outcome for patients with prostatic adenocarcinoma receiving definitive intensity-modulated radiotherapy (IMRT). Material and Method: This study included 142 patients who underwent definitive IMRT at National Taiwan University Hospital between December 2003 and December 2006. The median dose to the clinical target volume was 78 Gy (range: 73.1-82.3 Gy) in daily fractions of 1.91-2.11 Gy. Neoadjuvant hormonal therapy was given to 136 patients, usually starting 1 to 3 months before IMRT. The survival outcome was estimated using Kaplan-Meier method, and univariate and multivariate analyses were made with Log-rank test and Cox regression, respectively, on potential prognostic factors for survival. Results: The median follow-up time was 24.3 months. The 2-year overall survival (OS) was 95.4%. The 2-year failure-free survival (FFS), biochemical failure-free survival (BFFS), and distant metastasis-free survival (DMFS) rates for the whole cohort were 87.1%, 85.9%, and 97.6%, respectively. The 2-year FFS and BFFS were adversely influenced by T stage, Gleason score (GS) ＞7, and initial PSA (iPSA) serum level ＞20 ng/mL. The 2-year DMFS was adversely influenced by T stage, and GS ＞7. Multivariate analyses show that T stage is an independent factor for BFFS (p=.040), and FFS (p=.050), and that GS is an independent factor for DMFS (p=.037). Among the 17 patients with biochemical failure, the interval between PSA nadir and biochemical failure correlated significantly with 2-year DMFS (≤6 months 50.0% vs. ＞6 months 84.6%, p=.049). The rate of acute grade 2 gastrointestinal (GI) and genitourinary (GU) toxicities was 16.8% and 14%, respectively. The rate of late grade 2 GI and GU toxicities was 12.6% and 6.3%, respectively. Three patients (2.1%) developed late grade 3 GI toxicities. The use of a rectal balloon significantly reduced≥grade 3 late GI toxicity (without balloon it was 7.14% vs. with, 0 %, p=.046). Conclusion: Patients with prostatic adenocarcinoma undergoing definitive IMRT had T stage, initial PSA, and GS as significant prognostic factors for BFFS and FFS. T stage, GS, and the interval between PSA nadir and biochemical failure were prognostic factors for DMFS.
並列摘要
Purpose: We performed this retrospective analysis to evaluate prognostic factors and short-term outcome for patients with prostatic adenocarcinoma receiving definitive intensity-modulated radiotherapy (IMRT). Material and Method: This study included 142 patients who underwent definitive IMRT at National Taiwan University Hospital between December 2003 and December 2006. The median dose to the clinical target volume was 78 Gy (range: 73.1-82.3 Gy) in daily fractions of 1.91-2.11 Gy. Neoadjuvant hormonal therapy was given to 136 patients, usually starting 1 to 3 months before IMRT. The survival outcome was estimated using Kaplan-Meier method, and univariate and multivariate analyses were made with Log-rank test and Cox regression, respectively, on potential prognostic factors for survival. Results: The median follow-up time was 24.3 months. The 2-year overall survival (OS) was 95.4%. The 2-year failure-free survival (FFS), biochemical failure-free survival (BFFS), and distant metastasis-free survival (DMFS) rates for the whole cohort were 87.1%, 85.9%, and 97.6%, respectively. The 2-year FFS and BFFS were adversely influenced by T stage, Gleason score (GS) ＞7, and initial PSA (iPSA) serum level ＞20 ng/mL. The 2-year DMFS was adversely influenced by T stage, and GS ＞7. Multivariate analyses show that T stage is an independent factor for BFFS (p=.040), and FFS (p=.050), and that GS is an independent factor for DMFS (p=.037). Among the 17 patients with biochemical failure, the interval between PSA nadir and biochemical failure correlated significantly with 2-year DMFS (≤6 months 50.0% vs. ＞6 months 84.6%, p=.049). The rate of acute grade 2 gastrointestinal (GI) and genitourinary (GU) toxicities was 16.8% and 14%, respectively. The rate of late grade 2 GI and GU toxicities was 12.6% and 6.3%, respectively. Three patients (2.1%) developed late grade 3 GI toxicities. The use of a rectal balloon significantly reduced≥grade 3 late GI toxicity (without balloon it was 7.14% vs. with, 0 %, p=.046). Conclusion: Patients with prostatic adenocarcinoma undergoing definitive IMRT had T stage, initial PSA, and GS as significant prognostic factors for BFFS and FFS. T stage, GS, and the interval between PSA nadir and biochemical failure were prognostic factors for DMFS.
延伸閱讀
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- 張國楨、張慶雄、胡渝昌、陳建勳（2005）。早期攝護腺癌之手術治療與放射治療及其預後因子。放射治療與腫瘤學，12(1)，1-7。https://doi.org/10.6316/TRO/200512(1)1
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- Pai, L. C., Lian, S. L., Huang, C. J., Liu, C. C., Wu, W. J., Hsieh, H. C., & Huang, S. P. (2011). 攝護腺癌接受暫時性高劑量率插種治療與外部放射治療療效之評估. 放射治療與腫瘤學, 18(1), 47-58. https://doi.org/10.6316/TRO/201118(1)47
- 吳俊陽、林鈺芳、蕭文田、任秉豐、陳家睿、盧佳君、賴律翰（2021）。光激發光劑量計評估共平面調控放射治療於攝護腺癌治療計畫最佳化與劑量驗證研究。台灣應用輻射與同位素雜誌，17(1)，2079-2090。https://www.airitilibrary.com/Article/Detail?DocID=18156290-202103-202105120004-202105120004-2079-2090