中-高危前列腺癌大分割同步加量调强放疗的初步研究

Preliminary Study of Hypofractionated Simultaneous Intensity Modulated Radiotherapy for Medium-highRisk Prostate Cancer

目的初步探讨前列腺癌大分割同步加量调强放疗的近期疗效及不良反应。方法 2015年8月至2016年10月我院21例局限在盆腔的中-高危前列腺癌,接受前列腺加精囊腺放疗以及盆腔淋巴结引流区域预防照射。同步加量大分割调强放疗的剂量给予方式为前列腺及精囊腺2.5Gy/f,盆腔淋巴结引流区1.8Gy/f,共给予28次同步完成放疗。其中10例患者有核磁共振波谱分析(MRS)或者PET-CT(^(18) F-FDG或^(11) C-CHO)提示的较为明确的前列腺生物靶区,给予2.7Gy/f。21例均采用了CBCT或者3D超声图像引导放疗,均同时接受内分泌治疗。观察前列腺癌同步加量大分割调强放疗的疗效和近期不良反应。结果 21例患者的中位随访时间12个月(6~19个月),平均前列腺特异抗原由治疗前11.90ng/mL(4.50~75.00ng/mL)降至放疗后的0.78ng/mL(0.08~7.40)ng/mL。2例患者生化复发,2例患者生化及临床复发。消化道急性放疗反应发生2级为7例(33.3%),晚期反应发生2级为2例(9.5%)、未观察到3级及以上反应。泌尿道急性放疗反应发生2级为5例(23.8%)、未观察到3级及以上反应及晚期反应患者。结论中-高危前列腺大分割同步加量调强放疗近期疗效较为满意,严重不良反应少见,长期疗效和不良反应有待更长时间随诊评价。

Objective To explore the short-term efficacy and side effects of hypofractionated simultaneous intensity modu- lated radiation therapy for prostate cancer. Methods 21 patients with medium-high risk prostate cancer confined to pelvic cavity in our hospital from 2015.8 to 2016. 10 were treated with prostate plus seminal vesicle radiotherapy and prevention radiotherapy at lymph node drainage area of pelvic. The dose of hypofractionated simultaneous intensity- modulated radiation therapy was 2. 5Gy/ f to the prostate and the seminal vesicle, and 1.8Gy/f to the pelvic lymph node drainage area. The radiotherapy was performed 28 times. 10 cases had a relatively clear biological target area of the prostate given by MRS or PET-CT（ 18F-FDG or 11 C-CHO） , and were given 2. 7Gy/f. 21 cases were treated with CBCT or 3D ultrasound guided radiotherapy,and all received endocrine therapy at the same time. The efficacy and short-term side effects of simultaneous fractionated intensity- modulated radiation therapy for prostate cancer were observed. Results The median follow-up time of 21 patients was 12 months（6 - 19 months）. After radiotherapy The average prostatic specific antigen was reduced from 11.90ng/ml （ 4. 50 - 75.00 ng/ml） to 0. 78ng/ml （ 0. 08 ~ 7. 40） ng/ml. Biochemical relapse occurred in 2 patients and biochemical and clinical occurred in 2 patients. The acute radiation reaction of di- gestive tract in grade 2 occurred in 7 cases（33.3% ） ,and late reactions in grade 2（9.5% ）occurred in 2 cases,and there was no grade 3 or above reactions. The acute radiation response of urinarytract in grade 2 occurred in 5 cases （23.8 % ） , and there was no late reactions or grade 3 or above. Conclusion The short term curative effect of hypofractionated simultaneous intensity- modulated radiation therapy for medium-high risk prostate cancer is relatively satisfactory, and the severe adverse reaction is rare. The long-term effect and adverse reaction need to be evaluated for longer time.