射波刀治疗前列腺癌初步临床观察

Preliminary clinical study on treatment of prostate cancer with Cyber-Knife

目的探讨超大分割立体定向放射治疗(SBRT)前列腺癌的有效性和安全性。方法回顾性分析2010年5月至2018年5月治疗的26例前列腺癌患者。中位年龄69(57~87)岁。临床分期为局限期14例,转移期12例。放疗方案:18例为35.0~37.5 Gy/5次,其中1例5年前行调强放射治疗(IMRT) 72 Gy;8例为前列腺(25 Gy/5次)+盆腔(48.0~50.4 Gy/28次)。SBRT为隔日治疗,中位处方剂量线69.5%(65%~80%)。内分泌治疗:2例行去势手术,其余采用化学去势疗法。主要危及器官限量:直肠V35 Gy <1 cm3、膀胱V35 Gy <5 cm3。主要观察指标:放射损伤、前列腺特异性抗原(PSA)评价、局部控制、症状缓解。次要观察指标为无进展生存(PFS)和总生存(OS)。结果中位随访时间22.44个月,26例患者均顺利完成治疗,未出现≥3级早期和晚期放射损伤,1、2级早期放射损伤发生率分别为38.4%和19.2%,1、2级晚期放射损伤发生率分别为30.8%和3.8%。放疗后效果评价症状缓解及局部控制情况良好。放疗后1、3、6、12个月,局限期患者PSA值与放疗前相比均下降明显(Z=2.900、2.794、2.510、2.090, P<0.05),但转移期患者组差异均无统计学意义(P >0.05)。结论超大分割立体定向放射治疗前列腺癌局部控制效果好,症状缓解率高,无严重不良反应。

Objective To evaluate the safety and effectiveness of ultra-hypofractionated stereotactic body radiotherapy in the treatment of prostate cancer. Methods A total of 26 patients with prostate cancer treated with Cyber-Knife from May 2010 to May 2018 were analyzed retrospectively. The median age of the patients was 69 years old (range, 57 to 87). Ultra-hypofractionated radiotherapy was delivered in five fractions of 7.0-7.5 Gy for a total dose of 35.0-37.5 Gy. Androgen deprivation therapy (ADT) was administered in combination with the Cyber-Knife. The primary endpoints were radiation toxicity, PSA-response, local control and symptom alleviation, while the secondary endpoints were progression-free survival and overall survival. Results No graded ≥3 acute and late radiation toxicities occurred during follow-up. The acute toxicity of Grades 1 and 2 was 38.4% and 19.2%, while the late toxicity of Grades 1 and 2 was 30.8% and 3.8%, respectively. At a median follow-up of 22.44 months, for patients with localized stage, PSA level was decreased significantly after radiotherapy (Z=2.900, 2.794, 2.510, 2.090, P<0.05). However, there was no statistically significant difference for the metastatic group (P>0.05). Conclusions Ultra-hypofractionated stereotactic body radiotherapy is a safe and effective treatment for patients with prostate cancer.