摘要
目的探讨前列腺癌根治性治疗后异时性寡转移患者所有转移灶放疗(全覆盖放疗)的疗效和安全性。方法回顾性分析北京大学第一医院2011年10月至2021年2月收治的41例根治性治疗后寡转移(转移灶≤5处)前列腺癌患者的病例资料。放疗时中位年龄68(57~81)岁。40例(98%)接受雄激素剥夺治疗(ADT)。激素敏感性前列腺癌(HSPC)28例,去势抵抗性前列腺癌(CRPC)13例。初始最高PSA中位值24.4(7.4~399.0)ng/ml。肿瘤分期:T_(2)期11例,T3期27例,T4期3例;N0期30例,N1期11例(26.8%)。Gleason评分7分12例,8分9例,9分18例,10分2例。33例原发灶行手术治疗,8例原发灶行放疗。确诊至发生转移的时间为3.1(0.2~11.8)年。7例放疗前行传统影像学检查(CT/核磁/骨扫描)发现转移灶,34例行PSMA PET/CT检查发现转移灶。放疗前前列腺特异性抗原(PSA)中位值1.3(0.1~33.8)ng/ml。41例共62个转移灶,其中28例为1个,9例为2个,2例为3个,2例为5个;54个骨转移灶,8个腹膜后淋巴结转移灶。22个骨转移灶位于骨盆,18个位于椎体,12个位于肋骨,位于股骨、胸骨各1个。转移灶体积中位值5.8(0.2~81.7)cm^(3)。采用每日影像引导旋转调强放疗技术对所有转移灶全覆盖放疗。剂量分割模式包括37.5Gy/7.5Gy/5f、60Gy/3Gy/20f、65~70Gy/2.6~2.8Gy/25f。生物等效剂量(BED_(3))中位值为120(67~147)Gy。主要观察终点为无生化进展生存(BPFS),次要观察终点为急性期和晚期不良反应、无局部复发生存(LPFS)、总生存。结果本研究41例,中位随访时间21(5~72)个月。所有患者均完成放疗,16例(39.0%)出现急性期1~2级不良反应,无≥3级急性期和晚期不良反应。1年LPFS率为97.1%。1年和2年BPFS率分别为77.5%和59.2%,中位BPFS时间29.0(13.9~44.2)个月。单因素分析结果显示,HSPC组(P<0.001)和转移灶总体积≤5.8 cm^(3)组(P=0.010)的BPFS时间更长。腹膜后淋巴结转移亚组和骨转移亚组中位BPFS时间分别为37个月和17个月(P=0.141)。HSPC组中位BPFS时间为30(22~38)个月,28例放疗后PSA均下降,其中6例下降后上升,中位BPFS时间12(4~18)个月。CRPC组中位BPFS时间为4(0~8)个月,10例(76.9%)放疗后PSA下降,其中6例PSA下降后上升,中位BPFS时间5(3~28)个月;3例放疗后PSA未下降,采用新型内分泌治疗药物、化疗、免疫治疗等全身治疗。结论对于根治性治疗后异时性寡转移前列腺癌患者,全覆盖放疗安全性好、局部控制率高,推荐HSPC患者和低肿瘤负荷患者行异时性寡转移灶放疗;腹膜后淋巴结转移患者放疗效果优于骨转移患者。
Objective To investigate the efficacy and safety of radiotherapy for all metastases in patients with metachronous oligo-metastatic prostate cancer after radical treatment.Methods From October 2011 to February 2021,41 patients with prostate cancer with less than 5 metastases after radical treatment were retrospectively analyzed in a single center.The median age at radiotherapy was 68(57-81)years.Forty patients(98%)received androgen deprivation therapy(ADT).There were 28 patients in the hormone sensitive(HSPC)group and 13 patients in the hormone resistant(CRPC)group.The median initial PSA was 24.4(7.4-399.0)ng/ml.Tumor stage:T_(2) stage 11 patients,T3 stage 27 patients,T4 stage 3 patients.30 patients were in N0 stage and 11 patients in N1 stage.Gleason score was 7 in 12 patients,8 in 9 patients,9 in 18 patients,and 10 in 2 patients.33 patients were treated with surgery,and 8 patients were treated with radiotherapy.The time span from diagnosis to metastasis was 3.1(0.2-1.8)years.Conventional imaging examination(CT/MRI/bone scan)before radiotherapy was used in 7 patients,and PSMA PET/CT examination was used in 34 patients.The median PSA before radiotherapy was 1.3(0.1-33.8)ng/ml.There were 62 metastases in 41 patients,including 1 lesion in 28 patients,2 lesions in 9 patients,3 lesions in 2 patients,and 5 lesions in 2 patients.Fifty-four patients had bone metastases and eight had retroperitoneal lymph node metastases.Twenty-two bone metastases were located in the pelvis,18 in the vertebral body,12 in the ribs,one in the femur and one in the sternum.The median metastatic volume was 5.8(0.2-81.7)cm^(3).Daily image-guided rotational intensity modulated radiotherapy was used to cover all metastases.Dose segmentation modes include 37.5Gy/7.5Gy/5F,60Gy/3Gy/20F,65-70Gy/2.6-2.8Gy/25F.The median biological effective dose(BED_(3))was 120(67-147)Gy.The primary endpoint was biochemical progression-free survival(BPFS),the secondary endpoints were acute and late toxic side effects,local relapse-free survival(LPFS),and overall survival(OS).Results The median follow-up time was 21 months(range 5-72 months).All patients completed radiotherapy,and 16 patients had grade 1 to 2 acute toxicity and side effects,and no grade 3 or above acute and late stage side effects.1-year LPFS was 97.1%.The 1-year and 2-year BPFS were 77.5%and 59.2%,respectively.The median BPFS time was 29 months(range 13.9-44.2 months).Univariate analysis showed that the HSPC group(P<0.001)and the group with total metastatic volume≤5.8cm^(3)(P=0.010)had higher BPFS.The median BPFS time was 37 months in the retroperitoneal lymph node metastases subgroup and 17 months in the bone metastases subgroup(P=0.141).In the HSPC group,the median BPFS was 30(22-38)months.After radiotherapy,PSA decreased in all 28 patients,and increased in 6 patients.The median BPFS was 12(4-18)months.In the CRPC group,the median BPFS was 4(0-8)months.PSA decreased in 10 patients(76.9%)after radiotherapy,and PSA decreased in 6 patients.The median BPFS was 5(3-28)months.Three patients’PSA did not decrease after radiotherapy,and they were treated with new endocrine therapy drugs,chemotherapy,immunotherapy and other systemic therapy.Conclusions For patients with metachronous metastases after radical treatment,full coverage radiotherapy has good safety and high local control rate.HSPC patients and patients with low tumor load could be recommended to receive radiotherapy for all metastatic lesions preferentially,and patients with only retroperitoneal lymph node metastases may have better prognosis after radiotherapy than patients with bone metastases.
作者
亓昕
高献书
刘明珠
刘沛霖
李洪振
秦尚彬
马茗微
白赟
张敏
李晓梅
李晓颖
陈佳琰
任雪盈
周利群
Qi Xin;Gao Xianshu;Liu Mingzhu;Liu Peilin;Li Hongzhen;Qin Shangbin;Ma Mingwei;Bai Yun;Zhang Min;Li Xiaomei;Li Xiaoying;Chen Jiayan;Ren Xueying;Zhou Liqun(Department of Radiation Oncology,Peking University First Hospital,Beijing 100034,China;Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,Beijing 100034,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第9期656-661,共6页
Chinese Journal of Urology
基金
北京自然科学基金(7182164)
中华国际医学交流基金(2019-N-11-07、2019-N-11-08)。
关键词
前列腺肿瘤
寡转移
寡进展
放射治疗
Prostatic neoplasms
Oligo-metastasis
Oligo-progressive
Radiation therapy
