高剂量放射治疗前列腺癌

HIGH DOSE RADIOTHERAPY IN THE TREATMENT OF PROSTATE CANCER

1973～1989年间Lahey Clinic放疗科共收治前列腺癌499例,我们对病理诊断为腺癌、放射治疗剂量在64Gy以上的416例进行了分析。A_2及B期根治性放射治疗疗效与前列腺根治术相似,5年,10年局部控制率分别为92％及87％。5年,10年无瘤生存率:A_2期分别为90％及90％,B期为69％和52％;C期5年局部控制率为81％,5,10年无瘤生存率分别为47％和32％。说明高剂量放射治疗晚期前列腺癌仍可获得较好的局部控制,部分病人可长期生存。治疗失败的主要原因是远地转移。放疗量<70Gy或≥70Gy时,放射并发症的发生率无区别。总的并发症为5.5％。

All patients with adenocarcinoma of the prostate treated in this Department between 1973 and 1989 were reviewed. After excluding those who received a tumor dose less than 64 Gy, who had insuficient follow-up data and who had previously undergone radical prostatectomy, we analyzed a total of 395 cases. The median age was 69 years and median follow-up, 61 months. All patients were treated with x-ray with energies raging from 2. 5 MeV to 10 MeV. There were 36 Stage A patients, 216 Stage B patients, ill Stage C patients and 32 stage D patients. At present, 219 patients are alive with a median survival of 74 months . Sixty-six patients (17%) died from inter-current disease. As expected, the rates of metastasis increased proportionaly to stage of disease: 5 %, 29 % , 44 % and 72 % for stages A to D respectively. The rates of local, recurrence alone, on the other hand, were relatively low, at 5%, 8%, 11% and 6% for stages Ato D respectively. There was no statistical difference between patients who received 70 Gy or more and those who received less than 70 Gy. the overall complication rate of 5. 5% was quite acceptable. We conclude that high dose radiotherapy is very effective in local control for adenocarcinoma of the prostate, but unfortunately, many patients will continue to die from metastasi and intercurrent disease.