调强放疗联合内分泌治疗中晚期前列腺癌42例临床分析

Clinical analysis of intensity modulated radiotherapy combined with endocrine therapy for 42 patients with advanced prostate cancer

目的 分析调强放射治疗（IMRT）联合内分泌治疗对中晚期前列腺癌的短期治疗效果和副反应.方法 回顾性分析IMRT联合内分泌治疗中晚期前列腺癌42例患者的临床资料.放疗采用IMRT技术,1.8～2.0 Gy/次,5次/周,总放射量（DT）64 ～78 Gy,平均70.4 Gy.内分泌治疗采用去势同时加比卡鲁胺抗雄激素治疗的联合雄激素阻断治疗,28例放射治疗前接受手术去势,14例应用戈舍瑞林或亮丙瑞林药物去势.结果 42例均完成放射治疗,36例患者治疗6个月后血清PSA降至1ng/mL以下,放疗结束后尿频、排尿困难、里急后重等症状均有不同程度改善.1、2、3级急性胃肠道反应发生率分别为33.3％（14例）、9.5％（4例）、4.8％（2例）,1、2级急性泌尿生殖系统反应发生率为38.1％（16例）、9.5％（4例）.结论 IMRT联合内分泌治疗中晚期前列腺癌疗效满意,副反应发生率较低,是前列腺癌治疗的有效手段.

Objectives To analyze the short-term curative effect and side reaction of Intensity Modulated Radiation Therapy （IMRT） combined with endocrine therapy for advanced prostate cancer.Methods The clinical data of 42 patients with advanced prostate cancer treated by IMRT combined with endocrine therapy were analyzed retrospectively.The regimen of radiotherapy was taken as follow：1.8 ～ 2.0 Gy per fraction,once a day,five times a week,the DT was 64 ～ 78 Gy,and the average radiation dose was 70.4 Gy.The regimen of endocrine therapy was taken as follow：maximum androgen blockade.It was castration combined with anti androgen treatment of bicalutamide at the same time.There were 28 patients whom were castrated by operation before radiation therapy,and 14 patients were castrated by goserelin or leuprorelin.Results All patients had finished the radiation therapy.The serum PSA of 36 patients was decreased to below 1 ng/mL 6 months after the therapy.The frequency of urination,dysuria,tenesmus and other symptoms had been improved after radiation therapy.The incidence rate of 3 levels of acute gastrointestinal side reaction was 33.3％ （14 cases）,9.5％ （4 cases）,and 4.8 ％ （2 cases） respectively.The incidence rate of 2 levels of acute urinary system side reaction was 38.1％ （16 cases） and 9.5 ％ （4 cases） respectively.Conclusions The curative effect of IMRT combined with endocrine therapy for advanced prostate cancer is satisfied,and the incidence rate of the side reaction is low.It is an effective way for prostate cancer.