种族对高危前列腺癌患者在平等准入条件下接受中度低分割放疗的影响

David J Carpenter, Divya Natesan, R Warren Floyd, Taofik Oyekunle, Donna Niedzwiecki, Laura Waters, Devon Godfrey, Michael J Moravan, Rhonda L Bitting, Jeffrey R Gingrich, W Robert Lee, Joseph K Salama
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引用次数: 0

摘要

背景:中度低分割放疗(MHRT)是一种公认的治疗局限性前列腺癌的方法;然而,针对高危前列腺癌(HRPC)和/或非裔美国患者的MHRT数据有限。我们报告了在平等获取系统中治疗的HRPC患者的临床结果和毒性概况。方法:我们确定了在美国退伍军人事务部转诊中心接受MHRT治疗的HRPC患者。排除标准包括< 12个月随访和选择性淋巴结照射。MHRT包括70 Gy / 28分或60 Gy / 20分。急性和晚期胃肠道(GI)和泌尿生殖系统(GU)毒性使用不良事件通用术语标准5.0进行分级。临床终点,包括生化无复发生存期(BRFS)、无远处转移生存期(DMFS)、总生存期(OS)和前列腺癌特异性生存期(PCSS)使用Kaplan-Meier方法进行估计。通过logistic回归和log-rank检验比较非裔美国人和白人患者的临床结果、急性毒性和晚期无毒性生存。结果:2008年11月至2018年8月,143例HRPC患者接受了MHRT治疗,随访时间中位数为38.5个月;82例(57%)为非洲裔美国人,61例为白人患者。138例(97%)患者同时接受雄激素剥夺治疗(ADT),中位持续时间为24个月。非洲裔美国人和白人患者的5年OS无显著差异(73% [95% CI, 58%-83%] vs 77% [95% CI, 60%-97%];P = 55)、电脑(90%(95%可信区间,79% - -95%)和87%(95%可信区间,70% - -95%);P = .57)、时间(91%(95%可信区间,80% - -96%)和81%(95%可信区间,62% - -91%);P = 55),或BRFS(83%(95%可信区间,70% - -91%)和71%(95%可信区间,53% - -82%);P = 0.57)。急性3+级GU和GI的发生率总体较低(分别为4%和1%)。晚期毒性同样有利,种族间无显著差异。结论:在平等准入的环境下,HRPC患者接受MHRT治疗显示出良好的临床结果,没有种族差异,以及可接受的急性和晚期毒性发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Impact of Race on Outcomes of High-Risk Patients With Prostate Cancer Treated With Moderately Hypofractionated Radiotherapy in an Equal Access Setting.

Impact of Race on Outcomes of High-Risk Patients With Prostate Cancer Treated With Moderately Hypofractionated Radiotherapy in an Equal Access Setting.

Impact of Race on Outcomes of High-Risk Patients With Prostate Cancer Treated With Moderately Hypofractionated Radiotherapy in an Equal Access Setting.

Background: Moderately hypofractionated radiotherapy (MHRT) is an accepted treatment for localized prostate cancer; however, limited MHRT data address high-risk prostate cancer (HRPC) and/or African American patients. We report clinical outcomes and toxicity profiles for individuals with HRPC treated in an equal access system.

Methods: We identified patients with HRPC treated with MHRT at a US Department of Veterans Affairs referral center. Exclusion criteria included < 12 months follow-up and elective nodal irradiation. MHRT included 70 Gy over 28 fractions or 60 Gy over 20 fractions. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicities were graded using Common Terminology Criteria for Adverse Events, version 5.0. Clinical endpoints, including biochemical recurrence-free survival (BRFS), distant metastases-free survival (DMFS), overall survival (OS), and prostate cancer-specific survival (PCSS) were estimated using Kaplan-Meier methods. Clinical outcomes, acute toxicity, and late toxicity-free survival were compared between African American and White patients with logistic regression and log-rank testing.

Results: Between November 2008 and August 2018, 143 patients with HRPC were treated with MHRT and followed for a median of 38.5 months; 82 (57%) were African American and 61 were White patients. Concurrent androgen deprivation therapy (ADT) was provided for 138 (97%) patients for a median duration of 24 months. No significant differences between African American and White patients were observed for 5-year OS (73% [95% CI, 58%-83%] vs 77% [95% CI, 60%-97%]; P = .55), PCSS (90% [95% CI, 79%-95%] vs 87% [95 % CI, 70%-95%]; P = .57), DMFS (91% [95% CI, 80%-96%] vs 81% [95% CI, 62%-91%]; P = .55), or BRFS (83% [95% CI, 70%-91%] vs 71% [95% CI, 53%-82%]; P = .57), respectively. Rates of acute grade 3+ GU and GI were low overall (4% and 1%, respectively). Late toxicities were similarly favorable with no significant differences by race.

Conclusions: Individuals with HRPC treated with MHRT in an equal access setting demonstrated favorable clinical outcomes that did not differ by race, alongside acceptable rates of acute and late toxicities.

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