針對高風險族群攝護腺癌使用放射線合併荷爾蒙療法:治療經驗
蔡禮賢、黃志平、陳汶吉、楊啟瑞、張兆祥、吳錫金
中國醫藥大學附設醫院泌尿部
Oncological results in high risk group prostate patients between combined radiotherapy with hormone therapy: real world experience from Taiwan population
Li-Hsien Tsai, Chi-Pen Wang, Wen-Chi Chen, Chi-Rei Yang, Chao-Hsiang Chang, Hsi-Chin Wu
Department of Urology, China Medical University Hospital
Purpose:
Prostate cancer (PCa) is one of the most common male malignancy in the Western countries. Treatment option and survival outcome for PCa varied a lot depend on different risk stratification. Patients with high-risk Pca are at significant risk of biochemical failure, need for secondary therapy, distal metastasis, and disease-specific mortality rate. National Comprehensive Cancer Network (NCCN) suggests radiotherapy with hormone therapy (RT/HT) may be the first treatment option. Most of the previous studies about RT/HT in high-risk PCa were based on Caucasian population. And Asia population data is lacking. Our study aims to evaluate the oncological outcome and disease course of high-risk PCa patients with RT/HT
Materials and Methods:
Patients presented with high-risk PCa according to NCCN guideline at the single medical center were involved. We analyzed patient character, prostate-specific antigen (PSA), cancer staging, biochemical recurrence (BCR) free survival, disease-specific survival, the pattern of secondary hormone therapy and chemotherapy usage. Radiotherapy 75.6 Gy was done including the whole pelvis, prostate, and seminal vesicle. All patients received at least 2-year hormone therapy after radiotherapy finished.
Results:
Total 165 high-risk patients treated with RT/HT were enrolled. Median PSA was 45.96 (5.27 - 435.54). Clinical stage was T1 (25.5%), T2 (70.9%) and T3 (4.0%). The 5-year BCR-free survival for patients who received RT/HT was 84.8%. Overall survival and disease-specific survival were 77.6, 92.1%, respectively. No significant difference in cardiovascular mortality was noted in the treatment groups when comparing to the general population.
Conclusion:
High-risk PCa patients have significantly higher rate of biochemical failure, need for secondary therapy, distal metastasis, and disease-specific mortality rate and worse survival outcome compared with low-to-intermediate group patients. Hormone therapy applied as an adjuvant after definitive radiotherapy was associated both promising results of BCR free survival and disease-specific survival.