Optimizing External Beam Radiotherapy as per the Risk Group of Localized Prostate Cancer: A Nationwide Multi-Institutional Study (KROG 18-15)

Cancers

YoungSeok Kim¹  Jesang Yu¹  YeonJoo Kim¹  Taek-Keun Nam²  DongSoo Lee³  Youngmin Choi⁴  SuJung Shim⁵  BaeKwon Jung⁶  Hunjung Kim⁷  YoungJu Shin⁸  Youngkyong Kim⁹  Jae-Sung Kim^1,10  Bum-Sup Jang^1,10  JinHo Kim^1,11  Young-Hee Park^1,12  AhRam Chang^1,12  SeoHee Choi^1,13  JinHee Kim^1,14  Won Park^1,15  KwanHo Cho^1,16  SungUk Lee^1,16  Jaeho Cho^1,17 

[1]Asan Medical Center, Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul 05505, Korea

[2]Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Gwangju 61469, Korea

[3]Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Korea

[4]Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan 49201, Korea

[5]Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul 01830, Korea

[6]Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Korea

[7]Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon 22332, Korea

[8]Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul 04551, Korea

[9]Department of Radiation Oncology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea

[10]Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea

[11]Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea

[12]Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea

[13]Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea

[14]Keimyung University Dongsan Medical Center, Department of Radiation Oncology, Keimyung University School of Medicine, Daegu 42601, Korea

[15]Samsung Medical Center, Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea

[16]The Proton Therapy Center, National Cancer Center, Research Institute and Hospital, Goyang 10408, Korea

[17]Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea

关键词: prostate cancer;    radiotherapy;    NCCN;    risk assessment;    dose-escalation;    hypofractionation;   

DOI  :  10.3390/cancers13112732

来源: DOAJ

【 摘 要 】

Purpose: This nationwide multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancer patients. We compared various risk classification tools and assessed the need for refinements in current radiotherapy (RT) schemes. Methods and Materials: We included non-metastatic prostate cancer patients treated with primary EBRT from 2001 to 2015 in this study. Data of 1573 patients from 17 institutions were analyzed and re-grouped using a risk stratification tool with the highest predictive power for biochemical failure-free survival (BCFFS). We evaluated BCFFS, overall survival (OS), and toxicity rates. Results: With a median follow-up of 75 months, 5- and 10-year BCFFS rates were 82% and 60%, and 5- and 10-year OS rates were 95% and 83%, respectively. NCCN risk classification revealed the highest predictive power (AUC = 0.556, 95% CI 0.524–0.588; p < 0.001). Gleason score, iPSA < 12 ng/mL, intensity-modulated RT (IMRT), and ≥179 Gy_1.5 (EQD2, 77 Gy) were independently significant for BCFFS (all p < 0.05). IMRT and ≥179 Gy_1.5 were significant factors in the high-risk group, whereas ≥170 Gy_1.5 (EQD2, 72 Gy) was significant in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. Both BCFFS and OS improved significantly when ≥179 Gy_1.5 was delivered using IMRT and hypofractionation in the high-risk group without increasing toxicities. Conclusions: With NCCN risk classification, dose escalation with modern high-precision techniques might increase survivals in the high-risk group, but not in the low-risk group, although mature results of prospective studies are awaited.

【 授权许可】

Unknown