中晚期前列腺癌同期调强放疗联合内分泌治疗的临床观察

Clinical study of intensity modulated radiotherapy combined with endocrine therapy for middle-advanced stage prostate cancer

目的观察中晚期前列腺癌同步三维适形调强放疗联合内分泌治疗的疗效及不良反应。方法 67例中晚期前列腺癌患者接受同步三维适形调强放疗联合内分泌治疗:2.2～2.4Gy/f,每天1次,每周5次,共31次,DT 70～75Gy;放疗第1天起口服氟他胺0.25g/次,每天3次。评价疗效及不良反应,并分析影响放射性直肠损伤的因素。结果 67例患者均完成治疗,获CR 21例、PR 37例、SD 9例,总有效率(RR)为86.5%。随访时间为12.5～99.6个月,6例失访。随访满5年者(包括随访5年内死亡患者)共39例,其3、5年生存率分别为89.0%、80.5%,3、5年无进展生存率为72.0%、63.0%。肿瘤GTV≥141cm3者的中位生存时间为36.7个月,较GTV<141cm3者的56.9个月短,差异具有统计学意义(P=0.037)。全组患者白细胞减少和血红蛋白减少的发生率分别为91.0%、89.6%,急性肝损伤为3.0%,急性放射性肠炎和放射性膀胱炎分别为100.0%和95.5%。肿瘤GTV体积是影响放射性直肠损伤的因素(P<0.05)。结论同步适形调强放疗联合内分泌治疗治疗中晚期前列腺癌患者的有效率高,不良反应可耐受,预后良好。

Objective To evaluate the acute side effect and efficacy of intensity modulated radiotherapy（IMRT） combined with endocrine therapy for middle-advanced stage prostate cancer. Methods Sixty-seven patients with middle-advanced stage prostate cancer were treated by IMRT combined with endocrine therapy. The regimen was taken as follow： 2. 2-2.4Gy per fraction, once a day, five times a week, and DT was 70-75Gy; 0. 25g flutamide was administrated orally at the first day of radiotherapy, and three times a day. The side effects and clinical results were observed. Kaplan-Meier method was used to measure survival. The correlation between the acute radiation of intestinal injury and clinical factors were analyzed. Results There were 21 patients received CR, 37 patients re- ceived PR. The follow-up time was 12. 5-99. 6 months. The follow-up rate was 91.0%. Thirty-nine patients （ including death during 5- year follow-up） had a 5-year follow-up. The 3- and 5-year overall survival rates were 89. 0% and 89. 5% , respectively. The 3- and 5- year disease-free survival rates were 72.0% and 63.0%. The median survival time of patients with GTV≥ 141cm3 and patients with GTV 〈 141cm3 were 36. 7 months and 56. 9 months respectively, showing significant differences（P = 0. 037）. The rates of leucocytope- nia and decreased hemoglobin were 91.0% and 89. 6%. The incidences of acute radiation rectum damage and bladder damage were 100. 0% and 95.5 %. The GTV volume influenced acute radiation rectum damage（P 〈 0. 05 ）. Conclusion IMRT combined with en- docrine therapy for patients with middle-advanced stage prostate cancer is effective. The acute side effect is tolerable.