快中子治疗前列腺癌初报

Preliminary report on fast neutron therapy for prostate cancer

目的观察快中子与光子混合射线治疗前列腺癌的效果及毒副作用。材料与方法北京市快中子治疗协作组于１９９２年１月～１９９６年６月共收治前列腺癌１９例。用快中子与光子混合射线治疗１６例，快中子剂量为６００～１１６０ｎｃＧｙ，Ｘ线剂量为３０００～６０００ｃＧｙ，前列腺局部剂量为６４８０～７８００ｃＧｙ。单纯快中子治疗组剂量１０００～１２００ｎｃＧｙ。中子治疗多用前后－后前（ＡＰ－ＰＡ）照射野，Ｘ线用４野“盒式”技术或５野照射盆腔。结果全组患者放疗后泌尿系统症状改善率９３．８％；８４．６％患者的卡氏行为状态评分（ＫＰＳ）值改进。全组７例死亡（５例死于本病，２例死于并发症）。２年生存率１０／１４（７１．４％），２年肿瘤专项生存率（ｃａｎｃｅｒ－ｓｐｅｃｉｆｉｃｓｕｒｖｉｖａｌ）１０／１２（８３．３％）；３年生存率６／７（８５．７％），３年肿瘤专项生存率６／６（１００．０％）。全组１３例（６８．４％）出现急性放射反应。长期生存患者１２例中，７例（５８．３％）出现晚期反应，３例（２５．０％）为Ⅰ～Ⅱ度，４例（３３．３％）Ⅲ～Ⅳ度。结论混合射线对前列腺癌有较好的疗效，但严重并发症发病率也较高。

Purpose To present the preliminary results and side effects of fast neutron therapy for prostate cancer.Materials and Methods From January 1992 to June 1996,19 prostate cancer patients were treated at the Beijing Fast Neutron Therapy Coordination Group (3 with fast neutron and 16, with mixed fast neutron and photo therapy).Among these patients,one received palliative dose and the others, radical doses.Radiation doses in mixed beam group were fast neutron 600～1160ncGy ,plus photo therapy 3000～6000cGy,with the total local dose at the prostate gland of 6480～7800cGy;in fast neutron only group,the radiation dose given was 1000～1200ncGy,using AP～PA portals in the majority of patients. For photon therapy,four pelvic “box” portals or five portals technique was used. Results The urination improvement rate was 93.8%.the KPS improvement rate was 84.6%.Five patients died of tumor and 2, complications. The 2- and 3- year cancer-specific survival rates were 83.3%(10/12) and 100%(6/6). Acute radiation reactions were observed in 68.4%(13/19). Of 12 long_term survivors,58.3%(7) had late reactions.(Grades Ⅰ,Ⅱ:25% and Grade Ⅲ～Ⅳ :33.3%).Conclusion Mixed fast neutron-photon beam is able to improve the treatment result but has a higher morbidity rate.