Purpose: To compare two stereotactic body radiotherapy (SBRT) regimens in patients with intermediate- or high-risk prostate cancer with regards toxicity and efficacy. Methods/Material: We retrospectively collected data from 198 patients treated with SBRT for prostate cancer at two different institutions. Patients received either 35–36.25 Gy in five fractions (group A) using Cyberknife robotic platform or 42.7 Gy in seven fractions (group B) using a C-arm LINAC (image-guided). Propensity score matching was done (2:1 nearest neighbor matching without replacement), resulting in 120 patients (80 patients for group A, 40 patients for group B). Toxicity, PSA nadir, biochemical failure and disease-free survival (DFS) were analyzed. Results: Median follow up of all patients was 13 months (range 1–91 months). Overall, 23.3% of patients had ≥G2 acute GU toxicity (21.1% group A versus 30% group B (p= 0.222)) and 6.6% of patients ≥G2 GI toxicity (2.5% versus 15% (p= 0.010)). There was one acute G3 GU toxicity in arm A and one acute G4 rectal bleeding in group B (anticoagulated patient). Regarding late toxicity, 14.1% of patients had ≥G2 late GU toxicity (17.4% versus 6.6% (p= 0.159)) and 5.0% of patients had ≥G2 late GI toxicity (1.4% versus 13.3% (p= 0.013)). There was one G3 late GU toxicity in arm B and two G3 late GI toxicities, one in each arm. Relative median PSA reduction was 92.4% (−53.9–99.9%) from baseline PSA (93.7% (−53.9–99.9%) in group A versus 87.7% (39.8–99.9%) in group B (p= 0.043). In total, 4.2% of patients had biochemical relapse, 5.0% in group A and 2.5% in group B (p= 0.518). One-year DFS in the overall cohort was 97.3%, 98.8% in group A and 94.3% in group B (p= 0.318). Conclusion: Both SBRT regimens have acceptable acute and late toxicity and good efficacy. There are significantly more GI toxicities in the seven-fraction regimen. Longer follow-up is warranted for better comparison of long-term efficacy.
目的：比较两种立体定向体部放疗（SBRT）方案在中高危前列腺癌患者中的毒性和疗效。方法/材料：我们回顾性收集了来自两家不同机构的198例接受SBRT治疗的前列腺癌患者数据。患者分别接受两种方案治疗：A组使用射波刀机器人平台以5次分割给予35–36.25 Gy照射；B组使用C型臂直线加速器（图像引导）以7次分割给予42.7 Gy照射。通过倾向评分匹配（2:1最近邻匹配无放回），最终纳入120例患者（A组80例，B组40例）。分析指标包括毒性反应、PSA最低值、生化失败及无病生存期（DFS）。结果：所有患者中位随访时间为13个月（范围1–91个月）。总体而言，23.3%的患者出现≥2级急性泌尿系统毒性（A组21.1% vs B组30%，p=0.222），6.6%的患者出现≥2级急性胃肠道毒性（A组2.5% vs B组15%，p=0.010）。A组出现1例3级急性泌尿系统毒性，B组出现1例4级急性直肠出血（该患者接受抗凝治疗）。关于晚期毒性，14.1%的患者出现≥2级晚期泌尿系统毒性（A组17.4% vs B组6.6%，p=0.159），5.0%的患者出现≥2级晚期胃肠道毒性（A组1.4% vs B组13.3%，p=0.013）。B组出现1例3级晚期泌尿系统毒性，两组各出现1例3级晚期胃肠道毒性。相较于基线PSA值，中位PSA相对降幅为92.4%（范围-53.9–99.9%），其中A组为93.7%（-53.9–99.9%），B组为87.7%（39.8–99.9%）（p=0.043）。总体生化复发率为4.2%（A组5.0% vs B组2.5%，p=0.518）。全队列1年DFS为97.3%（A组98.8% vs B组94.3%，p=0.318）。结论：两种SBRT方案均具有可接受的急性及晚期毒性，且疗效良好。七分割方案胃肠道毒性显著更高。需要更长的随访时间以更好地比较长期疗效。
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