Abstract:Objective To evaluate the clinical efficacy and adverse events of intensity-modulated radiotherapy (IMRT) in the treatment of intermediate risk localized prostate cancer, and analyze the significance of prostate-specific antigen (PSA) level changes. Methods Clinical data of 66 patients with intermediate risk localized prostate cancer admitted to our hospital between 2007 and 2018 were retrospectively analyzed. Sixty patients were treated with endocrine therapy before radiotherapy. The radiation field covered the pelvic lymph node drainage area in 6 cases. Forty-seven patients received image-guided radiotherapy (IGRT). The median dose in the prostate and seminal vesicle was 78 Gy and 48 Gy in the pelvic lymph node drainage area. The survival rate was calculated using the Kaplan-Meier method. Results The median age was 77 years. The median follow-up time was 71.3 months. The 5-year sample size was 47. The 3-and 5-year overall survival (OS) was 98% and 90%.The 3-and 5-year cancer-specific survival (CSS) was 100% and 93%.The 3-and 5-year biochemical relapse-free survival was 97% and 86%.The mean time of PSA declining to the nadir was 5.83 months. The median level of PSA nadir was 0.06 ng/ml after IMRT. The incidence of grade I and Ⅱ early adverse events in the urinary system was 38% and 6%. The incidence of grade I and Ⅱ early adverse events in the gastrointestinal system was 21% and 3%. The incidence of grade I and Ⅱ advanced-stage adverse events in the urinary system was 9% and 2%. The incidence of grade I advanced-stage adverse events in the gastrointestinal system was 5%. Conclusions IMRT yields high clinical efficacy in the treatment of intermediate risk localized prostate cancer with a low risk of adverse events in the early and advanced stage. The monitoring of PSA after IMRT contributes to the assessment of clinical prognosis.
Zhong Qiuzi,Xiu Xia,Liu Yuanzhao et al. Clinical efficacy of intensity-modulated radiotherapy in treatment of 66 patients with intermediate risk localized prostate cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(6): 581-584.
[1] Abramowitz MC,Li T,Buyyounouski MK,et al. The Phoenix definition of biochemical failure predicts for overall survival in patients with prostate cancer[J].Cancer,2008,112(1):55-60. [2] 韩苏军,张思维,陈万青,等.中国前列腺癌发病现状和流行趋势分析[J].临床肿瘤学杂志,2013,18(4):330-334. Han SJ,Zhang SW,Chen WQ,et al. Analysis of the status and trends of prostate cancer incidence in China[J].Chin ClinOncol,2013,18(4):330-334.DOI:10.3969/j.issn.1009-0460.2013.04.009 [3] Dearnaley DP,Jovic G,Syndikus I,et al. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer:long-termresults from the MRC RT01 randomised controlled trial[J].Lancet Oncol,2014,15(4):464-473.DOI:10.1016/S14702045(14)70040-70043. [4] Denham JW,Steigler A,Joseph D,et al. Radiation dose escalation or longer androgen suppression for locally advanced prostate cancer?Data from the TROG03.04 RADAR trial[J].Radiother Oncol,2015,115(3):301-307.DOI:10.1016/j.radonc.2015.05.016. [5] Kuban DA,Tucker SL,Dong L,et al. Long-term results of the M.D.Anderson randomized dose-escalation trial for prostate cancer[J].Int J RadiatOncolBiol Phys,2008,70(1):67-74.DOI:10.1016/ j.ijrobp.2007.06.054. [6] Kalbasi A,Li J,Berman A,et al. Dose-escalated irradiation and overall survival in men with nonmetastatic prostate cancer[J].JAMA Oncol,2015,1(7):897-906.DOI:10.1001/jamaoncol.2015.2316. [7] D′Amico AV,Chen MH,Renshaw AA,et al. Androgen suppression and radiation vs. radiation alone for prostate cancer:a randomized trial[J].JAMA,2008,23;299(3):289-295.DOI:10.1001/jama.299.3.289. [8] Denham JW,Steigler A,Lamb DS,et al. Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer:10-year data from the TROG 96.01 randomisedtrial[J].Lancet Oncol,2011,12(5):451-459.DOI:10.1016/S1470-2045(11)70063-8. [9] Jones CU,Hunt D,McGowan DG,et al. Radiotherapy and short-term androgen deprivation for localized prostate cancer[J].N Engl J Med,2011,14;365(2):107-118.DOI:10.1056/NEJMoa1012348. [10] Shipley WU,Seiferheld W,Lukka HR,et al. Radiation with or without antiandrogen therapy in recurrent prostate cancer[J].N Engl J Med,2017,376(5):417-428.DOI:10.1056/NEJMoa1607529. [11] Pisansky TM,Hunt D,Gomella LG,et al. Duration of androgen suppression before radiotherapy for localized prostate cancer:radiation therapy oncology group randomized clinical trial 9910[J].J Clin Oncol,2015,33(4):332-9.DOI:10.1200/JCO.2014.58.0662. [12] Bolla M,Maingon P,Carrie C,et al. Short androgen suppressionand radiation dose escalation for intermediate-and high-risk localized prostate cancer:results of EORTC trial 22991[J].J Clin Oncol,2016,34(15):1748-1756.DOI:10.1200/JCO.2015.64.8055. [13] Reese AC,Pierorazio PM,Han M,et al. Contemporary evaluation of the national comprehensive cancer network prostate cancer risk classification system[J].Urology,2012,80(5):1075-1079.DOI:10.1016/j.urology.2012.07.040. [14] Loeb S,Folkvaljon Y,Robinson D,et al.evaluation of the 2015 gleason grade groups in a nationwide population-based cohort[J].Eur Urol,2016,69(6):1135-1141.DOI:10.1016/j.eururo.2015.11.036. [15] Epstein JI,Zelefsky MJ,Sjoberg DD,et al. A contemporary prostate cancer grading system:a validated alternative to the gleason score[J].Eur Urol,2016,69(3):428-435.DOI:10.1016/j.eururo.2015.06.046. [16] Epstein JI,Egevad L,Amin MB,et al. The 2014 international society of urological pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma:definition of grading patterns and proposal for a new grading system[J].Am J Surg Pathol,2016,40(2):244-252.DOI:10.1097/PAS.0000000000000530. [17] Rubin MA,Girelli G,Demichelis F.Genomic correlates to the newly proposed grading prognostic groups for prostate cancer[J].Eur Urol,2016,69(4):557-560.DOI:10.1016/j.eururo.2015.10.040. [18] Zumsteg ZS,Spratt DE,Pei I,et al. A new risk classification system for therapeutic decision making with intermediate-risk prostate cancer patients undergoing dose-escalated external-beam radiation therapy[J].Eur Urol,2013,64(6):895-902.DOI:10.1016/j.eururo.2013.03.033. [19] 钟秋子,李高峰,徐勇刚等.62例前列腺癌三维适形或调强放疗的临床研究[J].中华放射肿瘤学杂志,2010,19(3):231-235. Zhong QZ,Li GF,Xu YG,et al. Clinical outcomes of 62 patients with prostate carcinoma treated with three-dimensional conformal radiotherapy or intensity modulated radiotherapy[J].Chin J Radiat Oncol,2010,19(3):231-235.DOI:10.3760/ema.j.issn.1004-4221.2010.03.016. [20] Zhong Q,Gao H,Li G,et al. Significance of image guidance to clinical outcomes for localized prostate cancer[J].Biomed Res Int,2014,860639.DOI:10.1155/2014/860639.