调强放疗加内分泌治疗前列腺癌60例临床分析  

Intensity modulated radiation therapy combined with hormonotherapy for intermediate and advanced stage prostate carcinoma:clinical analysis of 60 cases

作　　者：杨伯平[1] 陈强[1] 任瑞美[1] 

机构地区：[1]山东省济南市中心医院,山东济南250013

出　　处：《中国现代医学杂志》2007年第16期2012-2014,2017,共4页China Journal of Modern Medicine

摘　　要：目的分析调强适形放射治疗(IMRT)联合内分泌治疗对中晚期前列腺癌的治疗效果。方法回顾性分析IMRT联合内分泌治疗中晚期前列腺癌60例的临床资料。内分泌治疗采用去势加抗雄激素治疗的联合雄激素阻断治疗,30例放射治疗前接受双侧睾丸切除,5例行睾丸放疗去势,25例应用抑那通药物去势。抗雄激素治疗药物应用氟他胺,与去势治疗同时应用。放疗采用IMRT技术,1.8～2.0Gy/次,5次/周,肿瘤量(DT)68～72Gy,平均剂量70Gy。结果1例治疗过程中突发心肌梗死死亡,1例因为急性阑尾炎而中断治疗,58例完成放射治疗。放疗结束后31例患者排尿困难等症状均不同程度改善,55例患者治疗6个月后血清PSA降至正常。平均随访30个月(6～75个月),3年和5年生存率分别为82.6%和71.1%,5年肿瘤特异生存率为83.4%,1、2、3级急性胃肠道反应发生率分别为33%、8%和3%,1、2级急性泌尿生殖系统反应发生率分别为33%、5%。结论IMRT联合内分泌治疗前列腺癌疗效满意,副反应小,是中晚期前列腺癌综合治疗的有效手段。[Objective] To evaluate the therapeutic effects of intensity modulated radiation therapy（IMRT）in combination with hormonotherapy in the treatment of intermediate and advanced prostate carcinoma. [Methods] The clinical records of 60 patients with prostate carcinoma treated with IMRT in combination hormonotherapy were retrospectively analyzed. The hormonotherapy consisted of emasculation and antiandrogen therapy （flutamide）. Of the 60 cases, 30 underwent bilateral orehiectomy before radiotherapy, 5 case received emasculation by radiotherapy and 25 cases by luteinizing hormonereleasing hormone agonist （enanton）. All the 58 patients received IMRT with a mean dose of 70 Gy, 1.8-2.0 Gy per fraction, 5 fractions weekly, DT 68-72 Gy. [Results] During the treatment, only 1 patient died of accidental myocardial infarction, 1 patient suffered from appendicitis, and the other 58 completed radiotherapy. After the treatment, voiding complaints were improved to varying degrees. Serum PSA level was normalized in 55 patients. The mean follow-up duration was 30 months （6-75 months）. The 3 and 5 year overall survival rates were 82.6% and 71.1%, respectively; and the 5 year disease specific survival rate was 83.4%%. The incidences of acute gastrointestinal side effects of grade Ⅰ , Ⅱor Ⅲwere 33%, 8%, 3%, respectively; the incidences of grade I or Ⅱ acute genitourinary side effects were 33% and 5% , respectively. [Conclusions] In patients with intermediate and advanced stage prostate carcinoma, IMRT in combination with hormonotherapy is an effective treatment option, which is well tolerated with minimal adverse effects.

关 键 词：前列腺肿瘤 调强适形放射治疗 内分泌治疗 

分 类 号：R737-23[医药卫生—肿瘤]