Aims

There is a paucity of long-term data on outcomes of high-risk prostatic adenocarcinoma after moderately hypofractionated radiotherapy with elective nodal treatment and long-term androgen deprivation therapy (ADT). We report long-term control and toxicity outcomes and analyse the predictors of failure and toxicity.

Materials and methods

The records of 120 consecutive high-risk prostate cancer patients treated in a single institution between February 2012 and December 2016 were retrospectively analysed. A moderately hypofractionted radiotherapy (HypoRT) regimen of 60 Gy in 20 fractions over 4 weeks with simultaneous elective pelvic irradiation to 44 Gy in 20 fractions with intensity-modulated radiotherapy was used, together with long-term ADT with either orchiectomy or medical castration for a total duration of 2–3 years. We analysed biochemical control, metastasis-free survival and late toxicities and their predictive factors using survival analysis.

Results

Patients had locally advanced cancers (cT3 77.5%, median pretreatment prostate-specific antigen 30 ng/ml, Gleason score 8–10 in 45.8%). The median follow-up time was 70 months. The 3- and 5-year probability of freedom from biochemical progression was 93% and 80%, respectively. The 5-year probability of freedom from local relapse/intra-pelvic nodal relapse/distant metastases as the site of first failure was 96%/97%/86%, respectively. Gleason score 8–10 and medical ADT for 2–3 years (as opposed to orchidectomy) were independent risk factors for distant metastases. A total of 18 grade 2 and above late gastrointestinal toxicity events and a total of 23 grade 2 and above late genitourinary toxicity events were documented. Patients who underwent a transurethral resection of prostate prior to radiotherapy had worse urological toxicity.

Conclusions

HypoRT with elective nodal treatment results in excellent pelvic control. Distant metastases are the primary mode of failure. Risk of metastases is associated with Gleason score and the duration of ADT. Late urinary toxicities are more common in those with prior transurethral resection of prostate.

中文翻译：

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高危局部前列腺癌的中度大分割放疗和雄激素剥夺治疗：长期生化控制和毒性的预测因子

目标

中度大分割放疗联合择期淋巴结治疗和长期雄激素剥夺治疗 (ADT) 后高危前列腺癌预后的长期数据很少。我们报告长期控制和毒性结果，并分析失败和毒性的预测因素。

材料和方法

回顾性分析了 2012 年 2 月至 2016 年 12 月在单一机构接受治疗的 120 名高危前列腺癌患者的记录。使用中度大分割放射治疗 (HypoRT) 方案，在 4 周内 60 Gy，20 次，同时选择性盆腔照射至 44 Gy，20 次，调强放疗，同时长期 ADT 联合睾丸切除术或药物去势治疗总工期2-3年。我们使用生存分析分析了生化控制、无转移生存和晚期毒性及其预测因素。

结果

患者患有局部晚期癌症（cT3 77.5%，治疗前前列腺特异性抗原中位数 30 ng/ml，格里森评分 8-10 占 45.8%）。中位随访时间为 70 个月。3 年和 5 年无生化进展的概率分别为 93% 和 80%。作为首次失败部位的局部复发/盆腔内淋巴结复发/远处转移的 5 年概率分别为 96%/97%/86%。Gleason 评分 8-10 分和 2-3 年的药物 ADT（与睾丸切除术相反）是远处转移的独立危险因素。共记录了 18 起 2 级及以上晚期胃肠道毒性事件和总共 23 起 2 级及以上晚期泌尿生殖系统毒性事件。在放疗前接受经尿道前列腺切除术的患者泌尿系统毒性更严重。

结论

选择性淋巴结治疗的 HypoRT 可实现出色的骨盆控制。远处转移是失败的主要方式。转移风险与 Gleason 评分和 ADT 持续时间相关。晚期泌尿系统毒性在先前经尿道前列腺切除术的患者中更为常见。