Effect of Large Prostate Volume on Efficacy and Toxicity of Moderately Hypofractionated Radiation Therapy in Patients With Prostate Cancer.

Autor: Natesan D; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Carpenter DJ; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Floyd W; Duke University School of Medicine, Durham, North Carolina., Oyekunle T; Biostatistics, Duke Cancer Institute, Durham, North Carolina., Niedzwiecki D; Biostatistics, Duke Cancer Institute, Durham, North Carolina., Waters L; Durham Veterans Affairs Medical Center, Durham, North Carolina., Godfrey D; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.; Durham Veterans Affairs Medical Center, Durham, North Carolina., Moravan MJ; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.; Durham Veterans Affairs Medical Center, Durham, North Carolina., Lee WR; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Salama JK; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.; Durham Veterans Affairs Medical Center, Durham, North Carolina.
Jazyk: angličtina
Zdroj: Advances in radiation oncology [Adv Radiat Oncol] 2021 Sep 14; Vol. 7 (2), pp. 100805. Date of Electronic Publication: 2021 Sep 14 (Print Publication: 2022).
DOI: 10.1016/j.adro.2021.100805
Abstrakt: Purpose: To evaluate the effect of prostate volume on outcomes after moderately hypofractionated radiation therapy (mHFRT) for prostate cancer.
Methods and Materials: Prostate cancer patients treated with mHFRT at a Veteran's Affairs Medical Center from August 20, 2008, to January 31, 2018, were identified. Patients were placed into a large prostate planning target volume (LPTV) cohort if their prostate PTV was in the highest quartile. Acute/late genitourinary (GU) and gastrointestinal toxicity events among patients with and without LPTV were compared. Multivariable analyses estimated the effect of factors on toxicity. Overall survival, biochemical recurrence-free survival, and freedom from late GU/gastrointestinal toxicity of patients with and without LPTV were estimated via Kaplan-Meier.
Results: Four hundred and seventy-two patients were included. Ninety-three percent received 70 Gy in 2.5 Gy fractions; 75% received androgen deprivation therapy. Median follow-up was 69 months. Patients with LPTV (PTV >138.4 cm 3 ) had a higher late 2 + GU toxicity compared with those without (59% vs 48%, P  = .03). Earlier time to late 2 + GU toxicity was associated with LPTV (hazard ratio 1.36; 95% confidence interval [CI], 1.00-1.86; P  = .047), androgen deprivation therapy use (hazard ratio 1.60; 95% CI, 1.13-2.27; P  = .01), and higher baseline American Urologic Association symptom score (odds ratio 1.03; 95% CI, 1.02-1.05; P < .001). At 2 years, freedom from late 2 + GU toxicity was 46% (95% CI, 47%-54%) for those with LPTV versus 61% (95% CI, 55%-65%) for those without ( P  = .04). Late grade 3 GU toxicity was 7% for those with LPTV and 4% for those without. No differences in overall survival or biochemical recurrence-free survival were observed between patients with or without LPTV.
Conclusions: LPTV did not affect efficacy of mHFRT for prostate cancer; however, it was associated with increased risk and earlier onset of late grade 2 + GU toxicity.
(© 2021 The Authors.)
Databáze: MEDLINE
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