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射波刀治疗前列腺癌寡转移灶的临床分析

The application of CyberKnife stereotactic body radiotherapy in treatment of oligometastatic prostate cancer

摘要:

目的 探讨射波刀立体定向放疗技术(stereotactic body radiotherapy,SBRT)治疗前列腺癌寡转移灶的有效性和安全性.方法 回顾性分析我院2012年5月至2017年2月应用射波刀治疗的31例前列腺癌患者的临床资料.年龄52 ~ 83岁,中位67岁.放疗前PSA0 ~ 300.0 ng/ml,中位数8.4 ng/ml.Gleason评分9例7分,7例8分,11例9分,2例10分,2例Gleason评分不详.从诊断前列腺癌至出现寡转移灶的时间为0~ 122.1个月,中位值8.4个月.出现寡转移灶至SBRT的时间为0.1~20.8个月,中位值1.3个月.本组31例包括50个寡转移灶和2例原发灶行射波刀治疗.治疗后每个月复查PSA,主要观察指标为PSA无进展生存(PSA progression-free survival,PSA-PFS)时间、PSA-PFS率、局部控制率(local control rate,LCR)、SBRT至放疗后开始去势治疗(androgen deprivation therapy,ADT)的时间.结果 31例患者均顺利完成治疗,未出现严重的早期反应和晚期反应.骨转移患者未出现放疗后骨折现象.中位随访时间20.7个月(1.2 ~58.3个月).中位PSA-PFS时间为5.3个月(0~58.3个月),1年PSA-PFS率为52.0%,2年PSA-PFS率为36.7%,4年PSA-PFS率为36.7%.21个转移灶放疗后PSA降低,该亚组患者的中位PSA-PFS时间为12.3个月(1.2 ~58.3个月);29个转移灶放疗后PSA进展.6个病灶局部控制失败,1年LCR为90.4%,2年LCR为86.9%,4年LCR为82.6%.随访结束时,12例患者放疗后未使用ADT治疗,中位随访时间为8.6个月(2.9~58.3个月);7例放疗后应用ADT治疗,从SBRT到开始ADT的中位时间为13.3个月(3.0 ~24.0个月);12例患者放疗前后持续ADT治疗.结论 射波刀治疗前列腺癌寡转移灶局部控制效果好,无严重不良反应.

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abstracts:

Objective To determine the effectiveness and safety of stereotactic body radiotherapy (SBRT)-CyberKnife for oligometastatic prostate cancer.Methods From May 2012 to February 2017,31 patients treated by CyberKnife were retrospectively reviewed,with a median age of 67 years(range 52 to 83 years),including 50 oligometastatic and 2 primary prostate cancer patients.The median PSA level was 8.4 ng/ml(range 0 to 300.0 ng/ml) and PSA test was performed every month.PSA progression-free survival (PSA-PFS),time to initiation of androgen deprivation therapy (ADT) and local control rate (LCR) were measured as the main outcomes.Results SBRT was well tolerated and were performed as planned in all patients.No SBRT related acute or late toxicities were observed.No bone fracture was observed in patients treated by bony targeted radiotherapy.The median follow-up after SBRT was 20.7.months (range 1.2-58.3 months).The median PSA-PFS was 5.3 months (range 0-58.3 months).1-year,2-year,and 4-year PSA-PFS was 52.0%,36.7% and 36.7% respe ctively.PSA level decrease was observed in 21 oligometastatic prostate cancer patients after SBRT,with median PSA-PFS of 12.3 months (range 1.2-58.3 months).PSA level increase was observed in 29 oligometastatic prostate cancer patients after SBRT.Six local recurrence were observed resulting in an actuarial 1-year,2-year and 3-year LCR of 90.4%,86.9% and 82.6%,respectively.Twelve patients treated without ADT after SBRT,with median follow-up of 8.6 months (range 2.9-58.3 months) in this subgroup.Seven patients were added ADT after SBRT,with the median time from SBRT to initiation of ADT of 13.3 months (range 3.0-24.0 months) in this subgroup.Twelve patients were treated with ADT continuously after SBRT.Conclusions CyberKnife seems to be a safe and effective treatment with tolerated adverse events and good local control for patients with oligometastatic prostate cancer.

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