立体定向放疗联合内分泌治疗转移性激素敏感性前列腺癌的临床研究

Stereotactic radiotherapy combined with endocrine therapy for metastatic hormone sensitive prostate cancer

目的:探讨立体定向放疗治疗转移性激素敏感性前列腺癌的有效性与安全性。方法:选取2016~2018年我院收治的转移性激素敏感性前列腺癌患者共80例,随机分为放疗组和对照组。对照组共40例,平均年龄(71.93±6.83)岁,中位前列腺特异性抗原(PSA)水平为317.7(71.19~911.83) ng/mL治疗方案为去势治疗+比卡鲁胺行全雄激素阻断。放疗组共40例,平均年龄(71.13±9.48)岁,中位PSA水平为300.35(100.00~799.23)ng/mL,治疗方案为去势治疗+比卡鲁胺行全雄激素阻断,在内分泌治疗3个月后行前列腺局部立体定向放疗,采用陀螺旋转式钴60放射治疗系统治疗,放疗剂量:50%GTV 3.0~3.5 Gy×10~11次,每周照射5次。观察血清PSA进展时间、PSA缓解率、3年生存率及不良反应。结果:两组患者中位随访28个月,放疗组失访1例,对照组失访2例。两组患者年龄、血清PSA、Gleason评分、T分期、骨转移数量、去势治疗方式(手术或药物去势)、进入去势抵抗性前列腺癌后采取的二线内分泌治疗方式比较差异均无统计学意义(P>0.05)。对照组的PSA进展中位时间为12.43个月(95%CI:10.80~14.78),放疗组的PSA进展中位时间为18.40个月(95%CI:10.99~25.81),比较差异有统计学意义(P<0.05)。两组PSA缓解率、3年生存率及不良反应比较差异无统计学意义(P>0.05)。放疗组的主要不良反应有放射性膀胱炎,CTCAE分级为1级,给予对症治疗后均在放疗后1个月内完全消失,两组均有1~2级的潮热及血糖升高,无须处理自行缓解。结论:对于转移性激素敏感性前列腺癌内分泌治疗同时早期给予前列腺局部立体定向放疗,与单独内分泌治疗相比可延长患者PSA进展时间,并且有延长患者总生存时间的趋势,不良反应轻微,患者耐受良好。

Objective: To investigate the efficacy and safety of stereotactic radiotherapy for metastatic hormone sensitive prostate cancer. Method: From 2016 to 2018, 80 patients with metastatic hormone sensitive prostate cancer were randomly divided into radiotherapy group and control group. There were 40 cases in the control group. The average age was(71.93±6.83) years old, and their median PSA level was 317.7(range, 71.19-911.83) ng/mL. Their treatment scheme was castration + bicalutamide for total androgen blocking. The radiotherapy group included 40 cases. The average age was(71.13±9.48) years old, and their median PSA level was 300.35(range, 100.00-799.23) ng/mL. Their treatment scheme was castration + bicalutamide for total androgen blocking. Three months later, they received stereotactic radiotherapy with the gyroscopic rotation 60Co radiotherapy system. The dose of radiotherapy was 50% GTV 3.0-3.5 Gy×10-11 times, 5 times a week. Time to PSA progression, PSA remission rate, 3-year survival rate and adverse reactions were observed. Result: The median follow-up time of the two groups was 28 months. One patient was lost in the radiotherapy group and two in the control group. There was no significant difference between the two groups in age, serum PSA, Gleason score, T stage, number of bone metastases, castration treatment(surgery or drug castration) or the second-line endocrine treatment after entering into castration resistant prostate cancer. The median time to PSA progression of the control group was 12.43 months(95%CI: 10.80-14.78), while that of the radiotherapy group was 18.40 months(95%CI: 10.99-25.81). There was no significant difference in PSA remission rate, 3-year survival rate or adverse reactions. The main adverse reactions in the radiotherapy group were radiation cystitis, and CTCAE was graded as grade 1. All of them disappeared completely within one month after the treatment. Both groups had 1-2 grade hot flashes and elevated blood glucose, which were relieved by themselves without treatment. Conclusion: Compared with endocrine therapy alone, endocrine therapy combined with stereotactic radiotherapy for metastatic hormone sensitive prostate cancer can prolong time to PSA progression, and has the trend of prolonging the total survival time of patients, with slight adverse reactions and good tolerance.