Preliminary Results of Biochemical Outcomes, Survival and Toxicity in Patients Treated with Intensity-Modulated Radiation Therapy for Localized Prostate Cancer

局限性攝護腺癌接受強度調控放射治療的初步生化無復發率、存活率及治療副作用的結果報告

吳貞達(Chen-Ta Wu) ； 賴家玄(Chia-Hsuan Lai) ； 洪照雄(Chao-Hsiung Hung) ； 劉國基(Kuo-Chi Liu) ； 陳妙芬(Miao-Fen Chen) ； 陳文政(Wen-Cheng Chen)

《放射治療與腫瘤學》 21卷1期 (2014/03) Pp. 1-12

https://doi.org/10.6316/TRO/201421(1)1

摘要

目的：局限性且無遠端轉移之攝護腺癌接受強度調控放射線治療初步的生化無復發存活率、存活率及治療副作用的結果報告。材料與方法：2003年12月至2012年3月，共87位有局限性且無遠端轉移之攝護腺癌病患於本科接受強度調控放射線治療。治療計劃利用逆算式電腦計劃系統搭配動態多葉型準直儀。病人是依美國國家癌症資訊網（NCCN）的攝護腺癌期別分類。生物化學失敗的臨床定義是採用2005年RTOG-ASTRO鳳凰城會議中所達成之共識－血液中測得的攝護腺特異抗原值大於最低值加2 ng/mL。病人接受治療的劑量介於61與78.4葛雷。治療後追蹤時間中位值是41個月（範圍介於10到105個月）。結果：三年的生化無復發存活率對於低危險群、中危險群、高危險群、非常高危險群分別是100%、100%、76.3%、88.5%。三年和五年的整體存活率分別是92%與80%。25位病人（28.7%）產生急性第二級腸胃道副作用，無病人有急性第三級以上的腸胃道症狀。19位病人（21.8%）產生急性第二級泌尿道症狀，而有一位病人出現尿滯留現象（第三級以上泌尿道副作用）。沒有病人產生慢性第二級以上腸胃道副作用。只有三位病人（3.5%）出現慢性第二級泌尿道症狀，但無病人產生慢性第三級以上泌尿道副作用。結論：從我們的結果來看，強度調控放射治療是攝護腺癌病人可行的臨床治療方式。初步的生化無復發存活率與其他強度調控放射治療的文獻相當，且伴隨少數的急性和慢性治療副作用。基於這有利的結果，強度調控放射線治療已成為本科治療局限性且無遠端轉移之攝護腺癌的標準模式。

關鍵字

攝護腺癌 ； 強度調控放射線治療 ； 生化無復發存活率

並列摘要

Purpose: To report preliminary biochemical outcomes, survival and toxicity for patients with localized prostate cancer treated with intensity-modulated radiotherapy (IMRT).Materials and Methods: Between December 2003 and March 2012, eighty-seven patients with clinically localized prostate cancer were treated with IMRT at our institution. Treatment was planned using an inverse-planning method. The beam intensity profiles were delivered by dynamic multileaf collimation. Patients were stratified by prognostic risk groups based on National Comprehensive Cancer Network (NCCN) risk classification criteria. Biochemical failure was defined using the 2005 ASTRO Phoenix consensus definition of the nadir prostate-specific antigen (PSA) concentration plus 2 ng/mL. Prescribed dose ranged from 61-78.4 Gy. The median follow-up time was 41 months (range: 10-105 months).Results : The 3-year actuarial biochemical relapse-free survival rates for low, intermediate, high, and very high risk group patients were 100%, 100%, 76.3%, and 88.5%, respectively. The 3- and 5-year actuarial overall survival rates were 92% and 80%. Twenty-five patients (28.7%) developed acute Grade 2 GI toxicity, and no patient experienced acute Grade 3 or greater rectal symptoms. Nineteen patients (21.8%) developed acute Grade 2 genitourinary (GU) symptoms, and one experienced Grade 3 or higher GU toxicity. No patient developed late Grade 2 or greater rectal toxicity. Only three patients (3.5%) experienced late Grade 2 GU toxicity. No late Grade 3 or greater GU complications have been observed.Conclusions: Our data demonstrate the feasibility of IMRT in the treatment of localized prostate cancer. Acute and late rectal toxicities are minimal. Short-term biochemical controls are comparable to published results of IMRT. Based on this favorable outcome, IMRT has become the standard treatment for localized prostate cancer at our institution.

並列關鍵字

Prostate cancer ； IMRT ； Biochemical relapse-free survival