前列腺癌根治性治疗后异时性寡转移灶全覆盖放疗的疗效分析  

Radiotherapy of all metastatic lesions in metachronous oligometastatic prostate cancer

作　　者：亓昕[1] 高献书[1] 刘明珠 刘沛霖 李洪振[1] 秦尚彬[1] 马茗微 白赟[1] 张敏[1] 李晓梅[1] 李晓颖[1] 陈佳琰 任雪盈 周利群[2] 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)

机构地区：[1]北京大学第一医院放射治疗科,100034 [2]北京大学第一医院泌尿外科北京大学泌尿外科研究所,100034

出　　处：《中华泌尿外科杂志》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)。

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=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 survi

关 键 词：前列腺肿瘤 寡转移 寡进展 放射治疗 

分 类 号：R737.25[医药卫生—肿瘤]