前列腺癌三维适形和调强放疗的初步结果

Three-dimensional conformal radiotherapy or intensity modulated radiation therapy for prostate cancer

目的分析三维适形放疗(3DCRT)和调强放疗(IMRT)前列腺癌的初步疗效和早晚期副反应。方法36例无远处转移的前列腺癌接受了3DCRT和IMRT,其中35例同时接受内分泌治疗。23例临床靶区包括前列腺或前列腺加精囊,13例先接受盆腔照射然后包括前列腺和精囊。临床靶区的中位剂量为76.0Gy(52.5～83.0Gy),盆腔预防性照射中位剂量为45.0Gy(40～50Gy)。结果3、5年总生存率分别为91%、84%。3、5年癌症相关生存率均为91%。全组早期胃肠道反应≤2级35例,3级1例,无4级反应;早期泌尿系统副反应≤2级34例,3级2例,无4级反应。全组分别有4例1级和3例2级晚期胃肠道反应,无≥3级晚期胃肠道反应;晚期泌尿系统反应发生率低,6例1级,2级1例,3级1例。结论应用三维适形放疗和调强放疗技术治疗前列腺癌,高剂量放疗是安全的,早期和晚期副反应可接受,未发现严重晚期副反应。

Objective To investigate the preliminary results and early,late side-effects of prostate cancer treated with three-dimensional conformal radiotherapy（3DCRT） or intensity modulated radiation therapy（ IMRT）. Methods From March 1999 to July 2004, 36 patients with stage T1-4N0-1M0 prostate cancer were treated with 3DCRT or IMRT. Of the 36 patients, 35 patients received androgen deprivation therapy during radiotherapy. Clinical target volume（CTV） encompassed the prostate and seminal vesicles. 3DCRT was given to 23 patients while 13 patients received IMRT. CTV and PTV received median dose of 76.0 Gy（52.5-83.0 Gy） and 45.0 Gy（40- 50Gy）. Results The 3- and 5-year overall survival rate was 91% and 84%, respectively. The 3- and 5-year disease-free survival rate were both 91% .Among these 36 patients, 35（97% ） developed ≤ grade 2 early gastrointestinal toxieities, 1 patient（3 % ） developed grade 3 toxicity, but no one showed any grade 4early G-I toxicity. The incidence of late urinary toxicity was low, with 6 patients（ 17% ） showing grade 1. I showing grade 2 and one showing grade 3 toxicity. Conclusions Prostate cancer treated with three-dimensional conformal radiotherapy or intensity modulated radiation therapy at high dose level is safe. The acute and late response is acceptable and no serious late response is observed.