三维适形放疗加内分泌治疗中晚期前列腺癌32例临床分析

Three-dimensional conformal radiotherapy combined with hormonotherapy for intermediate and advanced stage prostate carcinoma: clinical analysis of 32 cases

目的分析三维适形放射治疗（3D-CRT）联合内分泌治疗对中晚期前列腺癌的治疗效果。方法回顾性分析3D-CRT联合内分泌治疗中晚期前列腺癌32例的临床资料。内分泌治疗采用去势加抗雄激素治疗的联合雄激素阻断治疗，26例放射治疗前接受双侧睾丸切除，1例行睾丸放疗去势，5例应用抑那通药物去势。抗雄激素治疗药物应用氟他胺，与去势治疗同时应用。放疗采用3D-CRT技术，1．8～2．0Gy／次，5次／周，肿瘤量（DT）68～72Gy，平均剂量70Gy。结果1例治疗过程中突发心肌梗死死亡，31例完成放射治疗。放疗结束后31例患者排尿困难等症状均不同程度改善，25例患者治疗6个月后血清PSA降至正常。平均随访30个月（6～75个月），3、5年生存率分别为80．6％和69．1％，5年肿瘤特异生存率为80．4％，1、2、3级急性胃肠道反应发生率分别为43．7％、6．3％、3．1％，1、2级急性泌尿生殖系统反应发生率分别为34．4％、6．3％。结论3D-CRT联合内分泌治疗前列腺癌疗效满意，副反应小，是中晚期前列腺癌综合治疗的有效手段。

Objective To evaluate the therapeutic effects of three-dimensional conformal radiotherapy （3D-CRT） in combination with hormonotherapy in the treatment of intermediate and advanced prostate carcinoma. Methods The clinical records of 32 patients with prostate carcinoma treated with 3D-CRT in combination hormonotherapy were retrospectively analyzed. The hormonotherapy consisted of emasculation and anti-androgen therapy （flutamidc）. Of the 32 cases,26 underwent bilateral orchiectomy before radiotherapy, l case received emasculation by radiotherapy and 5 cases by luteinizing hormone-releasing hormone agonist （enanton）. All the 32 patients received 3D-CRT with a mean dose of 70 Gy, 1.8 ～2.0 Gy per fraction, ,5 fractions weekly,DT 68 -72 Gy. Results During the treatment,only 1 patient died of accidental myocardial infarction,the other 31 completed the radiotherapy. After the treatment,voiding complaints were improved to varying degrees. Serum PSA level was normalized in 25 patients. The mean follow-up duration was 30 months （6 - 75 months）. The 3- and 5-year overall survival rates were 80.6% and 69.1% , respectively ; and the 5-year disease-specific survival rate was 80.4%. The incidences of acute gastrointestinal side effects of grade Ⅰ , Ⅱ or Ⅲ were 43.7% ,6.3% , 3.1% ,respectively;the incidences of grade Ⅰ or Ⅱ acute genitourinary side effects were 34.4% and 6.3%, respectively. Conclusions In patients with intermediate and advanced stage prostate carcinoma, 3D-CRT in combination with hormonotherapy is an effective treatment option, which is well tolerated with minimal adverse effects.