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

    [Cancers (Basel).] Optimizing External Beam Radiotherapy as per the Risk Group of Localized Prostate Cancer: A Nationwide Multi-Institutional Study (KROG 18-15) 전립선암에서 위험도에 따른 최적 방사선치료 다기관연구 (KROG 18-15)

    연세의대, 성균관의대 / 최서희, 김영석, 박원*, 조재호*

  • 출처
    Cancers (Basel).
  • 등재일
    2021 May 31
  • 저널이슈번호
    13(11):2732. doi: 10.3390/cancers13112732.
  • 내용

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    Abstract
    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 Gy1.5 (EQD2, 77 Gy) were independently significant for BCFFS (all p < 0.05). IMRT and ≥179 Gy1.5 were significant factors in the high-risk group, whereas ≥170 Gy1.5 (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 Gy1.5 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.

     

     

    그림1) Survival graph - OS CSS BCFS

     

    그림2) 다양한 위험도 분류법에 따른 질병특이생존율

     

    Affiliations

    Seo Hee Choi  1   2 , Young Seok Kim  3 , Jesang Yu  3 , Taek-Keun Nam  4 , Jae-Sung Kim  5 , Bum-Sup Jang  5 , Jin Ho Kim  6 , Youngkyong Kim  7 , Bae Kwon Jung  8 , Ah Ram Chang  9 , Young-Hee Park  9 , Sung Uk Lee  10 , Kwan Ho Cho  10 , Jin Hee Kim  11 , Hunjung Kim  12 , Youngmin Choi  13 , Yeon Joo Kim  3   14 , Dong Soo Lee  15 , Young Ju Shin  16 , Su Jung Shim  17 , Won Park  18 , Jaeho Cho  2
    1 Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea.
    2 Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea.
    3 Asan Medical Center, Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul 05505, Korea.
    4 Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Gwangju 61469, Korea.
    5 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea.
    6 Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
    7 Department of Radiation Oncology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea.
    8 Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Korea.
    9 Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea.
    10 The Proton Therapy Center, National Cancer Center, Research Institute and Hospital, Goyang 10408, Korea.
    11 Keimyung University Dongsan Medical Center, Department of Radiation Oncology, Keimyung University School of Medicine, Daegu 42601, Korea.
    12 Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon 22332, Korea.
    13 Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan 49201, Korea.
    14 Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon 24289, Korea.
    15 Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Korea.
    16 Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul 04551, Korea.
    17 Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul 01830, Korea.
    18 Samsung Medical Center, Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

  • 키워드
    NCCN; dose-escalation; hypofractionation; prostate cancer; radiotherapy; risk assessment.
  • 연구소개
    본 연구는 서양인에게 주로 호발하던 전립선암이 음식문화의 서구화 등으로 한국에도 발병이 크게 늘어난 상황에 2001년부터 2015년까지 완치목적의 근치적방사선치료를 시행했던 1573명의 환자를 대상으로 하여 총 17개 기관이 참여한 다기관공동연구로 결실을 맺은 연구입니다. 해당기간 15년 동안 한국에서 전립선암 근치요법을 받은 환자들의 5년, 10년 생존율이 95%, 83%로 나왔으며, 전립선암의 위험군 분류상 고등급 및 중등급에서는 최신치료기법 및 고선량방사선이 생존율 증가에 도움이 된다는 것을 확인했으며, 저등급 전립선암에서는 선량증가가 필요한가 라는 의문을 던지고 있습니다. 아시아권에서도 이런 대규모 환자를 대상으로 한 전립선암 임상연구가 가능하다는 점과 기존에 알려진 위험등급에 따라 적정선량 및 치료방식에 대해서 방향성을 제시하고 있다는 점에서 의의가 있는 연구입니다.
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