调强放疗联合内分泌治疗中晚期前列腺癌的近期疗效观察

The effect of IMRT combined with endocrine therapy on the treatment of intermediate and advanced prostate cancer

目的 :观察调强放疗联合内分泌治疗中晚期前列腺癌的近期疗效及毒副反应。方法 :将患者分为A、B、C三组,即调强放疗+间歇内分泌治疗组(A组)50例,采用调强放疗,同步给予间歇性内分泌治疗(给药方式同C组);三维适形放疗+内分泌治疗组(B组)50例,采用三维适形放疗,同步给予间歇性内分泌治疗(给药方式同C组);两组均采用6MV的X射线照射,总剂量DT=70~76Gy,每次1.8~2Gy,每周5次;单纯内分泌治疗组(C组)50例,亮丙瑞林,3.75mg/次,皮下注射,每28天一次+比卡鲁胺50mg口服每日一次。随访3年,评价3组的疗效及不良反应。结果:A、B及C三组的有效率分别为84%、68%、46%,A、B组分别和C组比较均有显著差异;A组的毒副反应显著低于B组,与C组无显著差异;A组的1、2、3年生存率显著高于C组,A组的1年生存率显著高于B组,而A、B两组比较2、3年生存率无显著差异。结论 :调强放疗联合间歇性内分泌治疗中晚期前列腺癌的近期疗效好,毒副反应轻,患者大多能耐受,是一种行之有效的治疗方法。

Objective To observe the effect and toxicity of intensity modulated radiation therapy(IMRT)combined with endocrine therapy on the treatment of intermediate and advanced prostate cancer. Methods The patients were divided into A、B、C three groups, 50 patients in Group A were treated with IMRT combined with intermittent endocrine therapy,50 patients in Group B were treated with three-dimensional conformal radiotherapy(3D-CRT) combined with intermittent hormonal therapy,50 patients in group C were treated with alone intermittent hormonal therapy.The patients in Groups A and B received IMRT or 3D-CRT with a dose of 70-76 GY with 6MV of X-ray irradiation,1.8-2.0 GY per fraction,5 fractions per week.Endocrine therapy means leuprolide, 3.75 mg/times, subcutaneously, every 28 days + bicalutamide 50 mg orally once daily.The clinical results and side effects of 3 groups were observed by 3 years.Results The effective rate in A、B、 C group was 84%、68% and 46% respectively,comparing with Group C,the difference was statistically significant in Group A and B.The toxicity in Group A was significantly lower than in Group B,there was no significant difference between Group A and C.The 1,2,3-year survival rate in Group A was significantly higher than in Group C.The 1-year survival rate in Group A was significantly higher than in Group B.However,the 2,3-year survival rate difference was not significant between Group A and C. Conclusion IMRT combined with intermittent endocrine therapy can effectively improve the term effect and decreace the toxicity in the treatment of intermediate and advanced prostate cancer, most patients can also tolerate,it is an effective method of treatment.