中等大分割调强放疗联合内分泌治疗局部晚期前列腺癌的疗效分析  

The efficacy analysis of moderately hypofractionated IMRT combined with androgen deprivation therapy for locally advanced prostate cancer

作　　者：韦情虹 李进 邹丽娟[1] 徐晓颖[1] Wei Qinghong;Li Jin;Zou Lijuan;Xu Xiaoying(Department of Radiation Oncology,Second Hospital of Dalian Medical University,Dalian 116027,China)

机构地区：[1]大连医科大学附属第二医院放射肿瘤科,大连116027

出　　处：《中华放射医学与防护杂志》2023年第4期263-268,共6页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的探讨中等大分割调强放疗(IMRT)联合内分泌治疗局部晚期前列腺癌的疗效和不良反应。方法回顾性选取大连医科大学附属第二医院肿瘤放疗科2014至2020年收治的40例局部晚期前列腺腺癌患者的病例资料。前列腺及精囊腺计划肿瘤靶区(PGTV)剂量:64.8~70.0 Gy/25~28次,2.4~2.8 Gy/次,其中,20例盆腔阳性淋巴结同步加量PGTVnd剂量:60.0~64.4 Gy/25~28次,2.3~2.4Gy/次。盆腔淋巴结引流区计划靶区(PTV)剂量为45.0~50.4 Gy/25~28次。入组患者采用长程内分泌治疗,包括新辅助、同期及辅助治疗。评价疗效及不良反应,并分析影响无生化失败生存(BFFS)的预后相关因素。结果中位随访时间为31个月,全组患者2、3年的总生存(OS)率分别为100.0%、96.9%,1、2、3年的BFFS率分别为90%、76.8%、72%,无远处转移生存(DMFS)率分别为92.2%、82.8%、75.1%。Gleason(GS)评分高低(χ^(2)=10.00,P<0.05)和有无邻近组织受侵(χ^(2)=8.85,P<0.05)是局部晚期前列腺癌BFFS的预后相关因素,邻近组织受侵和GS评分9~10是独立预后不良因素。≥2级的急性泌尿系不良反应和直肠损伤发生率分别为7.5%和20%。≥2级的晚期泌尿系不良反应和直肠损伤发生率分别为12.5%和17.5%,未出现3~4级不良反应。结论中等大分割调强放疗联合长期内分泌治疗局部晚期前列腺癌是可行的,可获得较好的生存结果。70 Gy/25~28次、2.5~2.8 Gy/次是安全有效的中等大分割方案。邻近组织是否受侵和GS评分是局晚期前列腺癌无生化失败生存的预后相关因素。Objective To investigate the efficacy and adverse reactions of moderately hypofractionated intensity modulated radiation therapy(IMRT)combined with androgen deprivation therapy(ADT)for locally advanced prostate cancer(LAPC).Methods This study retrospectively analyzed the medical records of 40 LAPC patients who were admitted in The Second Hospital of Dalian Medical University during 2014-2020.The planning gross target volume(PGTV)dose for prostate gland and seminal vesicle gland was 64.8-70.0 Gy/25-28 f,2.4-2.8 Gy/f and the dose of PGTVnd in 20 cases with positive pelvic lymph nodes was 60.0-64.4 Gy/25-28 f,2.3-2.4 Gy/f.The dose of planning target volume(PTV)for the drainage area of pelvic lymph nodes was 45.0-50.4 Gy/25-28 f.The enrolled patients were treated with long-term ADT,including neoadjuvant,simultaneous,and adjuvant therapies.The efficacy and adverse reactions were evaluated.The prognostic factors affecting the biochemical failure-free survival(BFFS)were analyzed.Results The median follow-up time was 31 months.The 2-and 3-year overall survival(OS)rates were 100%and 96.9%,respectively.The 1-,2-,and 3-year BFFS rates were 90%,76.8%and 72%,respectively.The 1-,2-,and 3-year distant metastasis-free survival(DMFS)rates were 92.2%,82.8%and 75.1%,respectively.Gleason(GS)score(χ^(2)=10.00,P<0.05)and adjacent tissue invasion(χ^(2)=8.85,P<0.05)were prognostic factors related to BFFS for LAPC.Adjacent tissue invasion and GS 9-10 were independent poor prognostic factors.The incidence of acute urinary adverse reaction and rectal injury(grade≥2)was 7.5%and 20%,respectively.The incidence of late urinary adverse reaction and rectal injury(grade≥2)was 12.5%and 17.5%,respectively.Adverse reactions at grade 3-4 did not occur.Conclusions The moderately hypofractionated IMRT combined with ADT is feasible for LAPC treatment,achieving satisfactory survival effects.70 Gy/25-28 f,2.5-2.8 Gy/f is a safe and effective moderate hypofraction scheme.Adjacent tissue invasion and GS score are prognostic factors related to BFFS for

关 键 词：局部晚期前列腺癌 调强放射治疗 大分割 内分泌治疗 

分 类 号：R737.25[医药卫生—肿瘤]