Practical radiation oncology · 2026
"Cumulative incidence of toxicity between 2 and 5 years following SBRT to the prostate and pelvis nodes in patients with high-risk prostate cancer ".
СтатьяНазвание и аннотация: Перевод в очереди
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Martinez Constanza, Cury Fabio, Duclos Marie, Tsui James Man Git, Joseph Ackeem, Patrocinio Horacio, Souhami Luis, Faria Sergio
Аннотация
BACKGROUND AND PURPOSE: Stereotactic body radiotherapy (SBRT) is increasingly used for localized prostate cancer, but data on SBRT with pelvic nodal irradiation in patients with high-risk disease remain limited. We report late genitourinary (GU) and gastrointestinal (GI) toxicities and clinical outcomes in patients with high-risk prostate cancer treated with SBRT in 5 fractions to the prostate and pelvic lymph nodes.
MATERIALS AND METHODS: We reviewed 101 patients with high-risk prostate cancer treated with SBRT between August 2019 and May 2023. Treatment consisted of 36.25 Gy in 5 fractions to the prostate with a simultaneous dose of 25 Gy to the pelvic lymph nodes. Patients received 6 to 18 months of androgen deprivation therapy. Toxicity was prospectively assessed according to CTCAE version 4.0. Late toxicity was defined as events occurring ≥ 3 months after SBRT. Survival outcomes were estimated using Kaplan-Meier methods.
RESULTS: All patients had a minimum follow-up of 24 months. With a median follow-up of 43.8 months (range 26-70 months), late grade 1 and 2 GI toxicity occurred in 4 patients (4%), including three cases of rectal bleeding and one case of fecal incontinence. Late grade 1 and 2 GU toxicity occurred in 13 patients (13%), including 5 grade 2 events (5%). No grade ≥ 3 GI or GU toxicity was observed. The 5-year actuarial biochemical recurrence-free survival was 89.5%, with distant metastasis-free survival of 96.2% and overall survival of 98.8%.
CONCLUSION: SBRT delivered in five fractions with pelvic nodal irradiation appears feasible and associated with low rates of late GU and GI toxicity in patients with high-risk prostate cancer. Ongoing randomized trials will provide definitive evidence regarding the role of SBRT with pelvic nodal irradiation in this population.
MATERIALS AND METHODS: We reviewed 101 patients with high-risk prostate cancer treated with SBRT between August 2019 and May 2023. Treatment consisted of 36.25 Gy in 5 fractions to the prostate with a simultaneous dose of 25 Gy to the pelvic lymph nodes. Patients received 6 to 18 months of androgen deprivation therapy. Toxicity was prospectively assessed according to CTCAE version 4.0. Late toxicity was defined as events occurring ≥ 3 months after SBRT. Survival outcomes were estimated using Kaplan-Meier methods.
RESULTS: All patients had a minimum follow-up of 24 months. With a median follow-up of 43.8 months (range 26-70 months), late grade 1 and 2 GI toxicity occurred in 4 patients (4%), including three cases of rectal bleeding and one case of fecal incontinence. Late grade 1 and 2 GU toxicity occurred in 13 patients (13%), including 5 grade 2 events (5%). No grade ≥ 3 GI or GU toxicity was observed. The 5-year actuarial biochemical recurrence-free survival was 89.5%, with distant metastasis-free survival of 96.2% and overall survival of 98.8%.
CONCLUSION: SBRT delivered in five fractions with pelvic nodal irradiation appears feasible and associated with low rates of late GU and GI toxicity in patients with high-risk prostate cancer. Ongoing randomized trials will provide definitive evidence regarding the role of SBRT with pelvic nodal irradiation in this population.