Risk-adapted intensification therapy in high-risk prostate cancer: how relevant is the role of radiation dose.

IF 3.3 2区医学 Q2 ONCOLOGY

Radiation Oncology Pub Date : 2025-06-15 DOI:10.1186/s13014-025-02665-0

A Zapatero, M Roch, C Martín de Vidales, P Castro, N Montes, A Cruz Conde, Laura Fernández-Banda, Laura Zaragoza, Sara Carroceda, F García Vicente

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Abstract

Background/purpose: Dose escalation has demonstrated a significant improvement in biochemical recurrence in high-risk prostate cancer (HRPCa). We evaluated the impact on overall survival (OS) of dose intensification with external beam radiation therapy (EBRT) in a cohort of HRPCa patients treated in a single institution.

Methods and materials: Between January 1997 and January 2024, a total of 1451 consecutive localized PCa patients were treated with primary EBRT alone as part of a prospective institutional program for risk-adapted dose-intensification radiotherapy. For the present analysis, we specifically selected a cohort of 424 consecutive HRPCa patients with a minimum follow-up (FU) of 5 years. The median RT dose was 79.2 Gy (interquartile range [IQR] 74.9-80.3). Short and long-term hormones were administered in 56 (13%) and 350 (83%) of patients respectively. Kaplan-Meier curves were used to calculate overall survival (OS). Cumulative incidence of distant metastasis (DM), and cause specific survival (CSS) were estimated using competing risk regression.

Results: Median patient age was 69 years (IQR 65-72) and median FU was 118 months (IQR 88.0-135.0). At the time of analysis, 54 of 424 patients (13%) had died. The leading cause of death was cardiovascular disease in 16/54 patients (4%), followed by PCa in 15 patients (3%). At 10 and 15 years, the KM estimated OS rates were 91% (95% CI 87-93) and 71% (95% CI 61-79), respectively. The corresponding rates for MFS were 87% (95% CI 83-90) and 60% (95% CI 49-68), and for CSS were 97% (95% CI 95-99) and 90% (95% CI 49-81), respectively. In multivariate analysis, when adjusted for patient age, T stage, Gleason/ISUP group, PSA and length of hormone-therapy, higher radiation dose remained significantly associated with an improved OS (HR 0.89; 95% CI 0.84-0.94), MFS (HR 0.94; 95% CI 0.90-0.98) and CSS (HR 0.89; 95% CI 0.84-0.94).

Conclusions: The present study confirms that radiation dose intensification is paramount in the treatment of HRPCa with independence of duration of ADT.

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高危前列腺癌的风险适应强化治疗：放疗剂量的相关性如何？

背景/目的：剂量递增已证明可显著改善高危前列腺癌（HRPCa）的生化复发。我们评估了在单一机构接受治疗的HRPCa患者的剂量强化外束放射治疗（EBRT）对总生存期（OS）的影响。方法和材料：在1997年1月至2024年1月期间，共有1451例连续的局部PCa患者单独接受原发性EBRT治疗，作为风险适应剂量强化放疗的前瞻性机构计划的一部分。在目前的分析中，我们特别选择了424例连续HRPCa患者，最低随访（FU）为5年。中位放疗剂量为79.2 Gy（四分位数间距[IQR] 74.9-80.3）。56例（13%）和350例（83%）患者分别接受短期和长期激素治疗。Kaplan-Meier曲线计算总生存率（OS）。使用竞争风险回归估计远处转移（DM）的累积发生率和病因特异性生存（CSS）。结果：患者中位年龄为69岁（IQR 65-72），中位FU为118个月（IQR 88.0-135.0）。在分析时，424例患者中有54例（13%）死亡。主要死亡原因是心血管疾病（16/54）（4%），其次是PCa（15例）（3%）。在10年和15年，KM估计的OS率分别为91% （95% CI 87-93）和71% （95% CI 61-79）。MFS的相应发生率分别为87% （95% CI 83-90）和60% (95% CI 49-68)， CSS的相应发生率分别为97% （95% CI 95-99）和90% （95% CI 49-81）。在多因素分析中，当对患者年龄、T分期、Gleason/ISUP组、PSA和激素治疗时间进行调整后，较高的放射剂量仍然与改善的OS显著相关(HR 0.89；95% ci 0.84-0.94), MFS (hr 0.94；95% CI 0.90-0.98)和CSS (HR 0.89；95% ci 0.84-0.94)。结论：本研究证实放射剂量强化在HRPCa治疗中至关重要，与ADT持续时间无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.