三维适形放疗联合激素阻断治疗方案在晚期前列腺癌的临床应用

Three dimensional conformal radiotherapy combined with androgen deprivation therapy in clinical application of advanced prostate cancer

目的探讨三维适形放疗联合激素阻断治疗方案在晚期前列腺癌的f临床疗效。方法将本院2003年1月～2008年12月收治的60例晚期前列腺癌患者随机分为联合治疗组（放疗＋激素阻断）、单一组（激素阻断）两组，每组30例。联合组放疗采用三维适形放疗（总剂量70～72Gy，4～7周完成）加激素阻断治疗、单一激素阻断治疗组皆采用康士德＋诺雷德方案（康士德50rag／日，顿服，诺雷德3．75mg，皮下注射，1次／月，平均治疗周期12个月）。分别记录两组治疗后近期疗效（IPSS表评估下尿路症状缓解情况、VAS评分表评估疼痛情况、MRI复查评估肿瘤体积变化、血清PSA变化）、不良反应（胃肠道反应、肝肾功受损情况）、随访后评估患者生存率。结果联合治疗组相比单一治疗组，IPSS评分下降更明显，疼痛减轻更显著，前列腺肿瘤体积下降更明显，血清PSA变化下降更明显，差异比较均有统计学意义（P〈0．05）；不良反应相对较大，但差异比较无统计学意义（P〉0．05）；随访后患者生存率更高，差异比较有统计学意义（P〈0．05）。结论三维适形放疗联合激素阻断治疗方案最大限度的解除了患者病痛和提高了患者的生存率，可以为晚期前列腺癌尤其是非雄激素依赖型前列腺癌的临床诊治提供新的治疗方法。

Objectives To investigate the clinical efficacy of three dimensional conformal radiotherapy combined with androgen deprivation therapy in patients with advanced prostate cancer. Methods 60 cases of ad- vanced prostate cancer patients were randomly divided into combined treatment group （ radiotherapy and androgen deprivation） and single group （endocrine） from 2003 January to 2008 December in our hospital, 30 patients in each group. Combined radiotherapy group using three - dimensional conformal radiotherapy （ total dose for 70 - 72 Gy, to- tal time for 4 ~ 7 weeks） ; androgen deprivation therapy, androgen deprivation therapy groups using single Kang Shide ＋ Nored scheme （Kang Shide 50mg/day, orally, Nored 3.75 mg, subcutaneous injection, 1 times / month, the av- erage treatment period for 12 months）. Recorded the recent curative effect of the two groups after treatment （IPSS scale evaluation of lower urinary tract symptoms, VAS assessment pain, MRI assessment the changes of tumor size, serum PSA changing）, adverse reactions （ gastrointestinal reaction, liver and kidney function damaging） , following - up evaluate the survival rate of patients. Results In the treatment group compared with the single treatment group, IPSS score decreased more significantly, the pain is more significant, prostate tumor volume decreased more significantly, serum PSA levels decreased significantly, differences were statistically significant（ P 〈 0.05 ） ; adverse reaction is relatively large, but the difference is no statistic significance（ P 〉 0.05 ） ;follow -up survival rate is high- er, the difference was statistically significant （ P 〈 0.05 ）. Conclusions Dimensional conformal radiotherapy combined with androgen deprivation therapy maximum relieves the pain of patients and improve survival in patients with advanced prostate cancer, can provide a new therapeutic approach for clinical diagnosis and treatment for ad- vanced prostate cancer patients especially for androgen independent prostate cancer.