Long-term treatment outcomes from the International Multi-Institutional Stereotactic Body Radiation Therapy for High-Risk Localized Carcinoma of the Prostate (SHARP) Consortium.
Notice bibliographique
Résumé
323 Background: Stereotactic body radiation therapy (SBRT) leverages advanced image-guided radiotherapy techniques to deliver high doses of radiation over the course of 5 or fewer treatments. High-risk localized prostate cancer has been historically treated with more protracted conventional radiotherapeutic techniques, though use of SBRT is now supported in this setting by subgroup analyses of randomized trials as well as medium-term prospective data from phase II trials. However, most patients with high-risk prostate cancer continue to receive extended treatment courses in part due to trepidation surrounding the long-term outcomes of SBRT in high-risk disease. We sought to report long-term efficacy and toxicity outcomes from the SHARP consortium for men with high-risk prostate cancer treated with SBRT. Methods: Individual patient data from men prospectively treated on five clinical trials evaluating SBRT for high-risk prostate cancer across five institutions were pooled. Analysis was limited to patients with more than 24 months of follow-up. Adjusted 5-year overall survival (OS) was calculated for the entire cohort of high-risk patients. Kaplan-Meier analyses estimated 5-year biochemical recurrence-free survival (BCRFS) and 5-year distant metastasis-free survival (DMFS) stratified by receipt of androgen deprivation therapy (ADT). Multivariate analysis quantified the benefit of adding ADT to SBRT, adjusting for patient age, iPSA, Gleason Score, T category, ADT use, and nodal radiation. Crude rates of CTCAE grade 3 or greater GI or GU toxicity were calculated. Results: Data from 373 prospectively treated patients were pooled for analysis. Median follow-up time was 60.2 months. 282 (75.6%) patients received ADT for a median duration of 9 months. Adjusted 5-year overall survival was 87.9% (95% CI 84.2%-91.6%). Estimated 5-year BCRFS for men who received ADT was 81.4% (95% CI 76.2% - 86.5%) compared to 77.2% (95% CI 66.9% -87.6%) for men who did not (logrank p=0.04). Estimated 5-year DMFS was 92.4% (95% CI 89.1%-95.8%) for men who received ADT versus 93.6% (95% CI 87.5%-99.8%) for men who did not (logrank p=0.62). On MVA, adjusted HR for BCRFS with use of ADT compared to no ADT was 0.7 (p=0.017). Crude incidence rate of late grade 3 or greater genitourinary or gastrointestinal toxicity was 4.1%. Conclusions: The safety and efficacy profile of SBRT for high-risk prostate cancer remains favorable at long-term follow-up. ADT of medium duration improves BCRFS in men with high-risk prostate cancer but did not reduce the incidence of metastatic failure at a median of 60 months. SBRT and ADT should be routinely integrated into shared decision-making for men with high-risk prostate cancer pursuing definitive radiotherapeutic treatment.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».