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首页> 外文期刊>Frontiers in Oncology >Intensity-Modulated Radiation Therapy with Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: The Georgetown University Experience
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Intensity-Modulated Radiation Therapy with Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: The Georgetown University Experience

机译：立体定向放射疗法增强强度调节放射疗法治疗不利的前列腺癌：乔治敦大学的经验

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Purpose/objective(s) Stereotactic body radiation therapy (SBRT) is emerging as a minimally invasive alternative to brachytherapy to deliver highly conformal, dose--escalated radiation therapy (RT) to the prostate. SBRT alone may not adequately cover the tumor extensions outside the prostate commonly seen in unfavorable prostate cancer. External beam radiation therapy (EBRT) with high dose rate brachytherapy boost is a proven effective therapy for unfavorable prostate cancer. This study reports on early prostate-specific antigen and prostate cancer-specific quality of life (QOL) outcomes in a cohort of unfavorable patients treated with intensity-modulated radiation therapy (IMRT) and SBRT boost. Materials/methods Prostate cancer patients treated with SBRT (19.5?Gy in three fractions) followed by fiducial-guided IMRT (45–50.4?Gy) from March 2008 to September 2012 were included in this retrospective review of prospectively collected data. Biochemical failure was assessed using the Phoenix definition. Patients completed the expanded prostate cancer index composite (EPIC)-26 at baseline, 1?month after the completion of RT, every 3?months for the first year, then every 6?months for a minimum of 2?years. Results One hundred eight patients (4 low-, 45 intermediate-, and 59 high-risk) with median age of 74?years completed treatment, with median follow-up of 4.4?years. Sixty-four percent of the patients received androgen deprivation therapy prior to the initiation of RT. The 3-year actuarial biochemical control rates were 100 and 89.8% for intermediate- and high-risk patients, respectively. At the initiation of RT, 9 and 5% of men felt their urinary and bowel function was a moderate to big problem, respectively. Mean EPIC urinary and bowel function and bother scores exhibited transient declines, with subsequent return to near baseline. At 2?years posttreatment, 13.7 and 5% of men felt their urinary and bowel function was a moderate to big problem, respectively. Conclusion At 3-year follow-up, biochemical control was favorable. Acute urinary and bowel symptoms were comparable to conventionally fractionated IMRT and brachytherapy. Patients recovered to near their baseline urinary and bowel function by 2?years posttreatment. A combination of IMRT with SBRT boost is well tolerated with minimal impact on prostate cancer-specific QOL.
机译：目的/目标立体定向放射疗法（SBRT）逐渐成为近距离放射疗法的一种微创替代方案，可以向前列腺提供高度适形的剂量递增放射疗法（RT）。单独使用SBRT可能无法充分覆盖在不利的前列腺癌中常见的前列腺外肿瘤扩展。具有高剂量率近距离放射治疗增强作用的外部束放射疗法（EBRT）是一种治疗不利前列腺癌的有效疗法。这项研究报告了一组接受强度调制放射治疗（IMRT）和SBRT强化治疗的不良患者的早期前列腺特异性抗原和前列腺癌特异性生活质量（QOL）结果。材料/方法自2008年3月至2012年9月，先后接受SBRT（三分之19.5？Gy）和基准引导的IMRT（45-50.4？Gy）治疗的前列腺癌患者纳入了这项前瞻性收集的回顾性研究。使用Phoenix定义评估生化失败。患者在完成RT后1个月时，在基线时完成基线的扩展前列腺癌指数复合物（EPIC）-26，第一年每3个月一次，然后每6个月至少2年。结果中位年龄74岁的108例患者（低危4例，中高危4例，高危59例）完成了治疗，中位随访时间为4.4年。 64％的患者在开始RT之前接受了雄激素剥夺治疗。中危和高危患者的3年精算生化控制率分别为100和89.8％。在逆转录治疗开始时，分别有9％和5％的男性感到他们的泌尿和肠功能是中度到大问题。 EPIC的平均尿，肠功能和打扰得分表现为短暂下降，随后恢复至接近基线。在治疗后2年，分别有13.7和5％的男性感到他们的泌尿和肠功能是中度到大问题。结论在3年的随访中，生化控制良好。急性尿和肠症状与常规分次IMRT和近距离放射疗法相当。治疗后2年，患者恢复到接近其基线尿和肠功能。 IMRT与SBRT增强相结合的耐受性良好，对前列腺癌特异性QOL的影响极小。

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