- 作者：Daniel E. Spratt ; MD ; Xin Pei ; PhD ; Josh Yamada ; MD ; Marisa A. Kollmeier ; MD ; Brett Cox ; MD ; Michael J. Zelefsky ; MD ; zelefskm@mskcc.org
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2013
- 出版时间：1 March, 2013
- 年：2013
- 卷：85
- 期：3
- 页码：686-692
- 全文大小：372 K
Purpose
To report long-term survival and toxicity outcomes with the use of high-dose intensity modulated radiation therapy (IMRT) to 86.4 Gy for patients with localized prostate cancer.Methods and Materials
Between August 1997 and December 2008, 1002 patients were treated to a dose of 86.4 Gy using a 5-7 field IMRT technique. Patients were stratified by prognostic risk group based on National Comprehensive Cancer Network risk classification criteria. A total of 587 patients (59 % ) were treated with neoadjuvant and concurrent androgen deprivation therapy. The median follow-up for the entire cohort was 5.5 years (range, 1-14 years).
Results
For low-, intermediate-, and high-risk groups, 7-year biochemical relapse-free survival outcomes were 98.8 % , 85.6 % , and 67.9 % , respectively (P<.001), and distant metastasis-free survival rates were 99.4 % , 94.1 % , and 82.0 % (P<.001), respectively. On multivariate analysis, T stage (P<.001), Gleason score (P<.001), and >50 % of initial biopsy positive core (P=.001) were predictive for distant mestastases. No prostate cancer-related deaths were observed in the low-risk group. The 7-year prostate cancer-specific mortality (PCSM) rates, using competing risk analysis for intermediate- and high-risk groups, were 3.3 % and 8.1 % , respectively (P=.008). On multivariate analysis, Gleason score (P=.004), percentage of biopsy core positivity (P=.003), and T-stage (P=.033) were predictive for PCSM. Actuarial 7-year grade 2 or higher late gastrointestinal and genitourinary toxicities were 4.4 % and 21.1 % , respectively. Late grade 3 gastrointestinal and genitourinary toxicity was experienced by 7 patients (0.7 % ) and 22 patients (2.2 % ), respectively. Of the 427 men with full potency at baseline, 317 men (74 % ) retained sexual function at time of last follow-up.
Conclusions
This study represents the largest cohort of patients treated with high-dose radiation to 86.4 Gy, using IMRT for localized prostate cancer, with the longest follow-up to date. Our findings indicate that this treatment results in excellent clinical outcomes with acceptable toxicity.