« Augmented radiotherapy » in the management of high-risk prostate cancer (PCa): A systematic review.

Jennifer Le Guévelou, Vedang Murthy, Thomas Zilli, Luca Nicosia, Alberto Bossi, Leonard P Bokhorst, Eric Barret, Idir Ouzaid, Paul L Nguyen, Federica Ferrario, Cyrus Chargari, Stefano Arcangeli, Nicolas Magne, Paul Sargos
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Abstract

Background: In patients with high-risk (HR) prostate cancer (PCa) treated with radiotherapy and androgen deprivation therapy (ADT), intensification with androgen receptor pathway inhibitor (ARPI) improves overall survival (OS), at the cost of significant side-effects. We hypothesized that "augmented RT" schedules (defined as either dose-escalation on the prostate gland over 78 Gy and/or addition of whole pelvic radiotherapy (WPRT)), combined with long-term ADT can reach excellent prostate cancer specific survival (PCSS) in this population with little detrimental impact on quality of life.

Methods: We searched Pubmed database until February 8, 2024. Studies reporting both oncological and toxicity outcomes after "augmented RT" were deemed eligible. Studies without ADT or with ARPI intensification were deemed ineligible.

Results: Dose-escalation within the prostate gland at doses over 78 Gy halved the risk of biochemical recurrence at 5 years, with however no impact on PCSS. The addition of WPRT provides a 5-year disease-free survival (DFS) reaching 89.5 % at 5 years, with no significant increase in late grade≥ 2 genito-urinary (GU) or gastrointestinal (GI) toxicity. Combined approaches result in 9-year PCSS ranging between 96.1 % and 100 %. Most approaches demonstrated excellent safety profiles.

Conclusions: "Augmented RT" reached excellent oncological outcomes, with minimal additional toxicity. The development of biomarkers might lead to further treatment personalization, in the rapidly evolving landscape of systemic therapies.

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“增强放疗”在高危前列腺癌(PCa)治疗中的应用:一项系统综述。
背景:在接受放疗和雄激素剥夺治疗(ADT)的高危(HR)前列腺癌(PCa)患者中,雄激素受体途径抑制剂(ARPI)的强化治疗可提高总生存率(OS),但代价是显著的副作用。我们假设“增强放疗”计划(定义为前列腺剂量增加超过78Gy和/或增加全盆腔放疗(WPRT)),结合长期ADT可以在该人群中达到极好的前列腺癌特异性生存率(PCSS),对生活质量几乎没有不利影响。方法:检索Pubmed数据库至2024年2月8日。报告“增强型放射治疗”后肿瘤和毒性结果的研究被认为是合格的。没有ADT或ARPI增强的研究被认为不合格。结果:前列腺内剂量增加,剂量超过78Gy, 5年生化复发风险减半,但对PCSS没有影响。WPRT的加入使5年无病生存率(DFS)达到89.5%,晚期≥2级泌尿生殖系统(GU)或胃肠道(GI)毒性没有显著增加。综合方法的9年PCSS范围在96.1%至100%之间。大多数方法显示出良好的安全性。结论:“增强型放射治疗”达到了极好的肿瘤学结果,并且具有最小的额外毒性。在快速发展的全身治疗领域,生物标志物的发展可能会导致进一步的治疗个性化。
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