66例局限期中危前列腺癌IMRT疗效分析

摘要

Objective To evaluate the clinical efficacy and adverse events of intensity-modulated radiotherapy ( IMRT ) in the treatment of intermediate risk localized prostate cancer, and analyze the significance of prostate-specific antigen ( PSA) level changes. Methods Clinical data of 66 patients with intermediate risk localized prostate cancer admitted to our hospital between 2007 and 2018 were retrospectively analyzed. Sixty patients were treated with endocrine therapy before radiotherapy. The radiation field covered the pelvic lymph node drainage area in 6 cases. Forty-seven patients received image-guided radiotherapy ( IGRT) . The median dose in the prostate and seminal vesicle was 78 Gy and 48 Gy in the pelvic lymph node drainage area. The survival rate was calculated using the Kaplan-Meier method. Results The median age was 77 years. The median follow-up time was 71. 3 months. The 5-year sample size was 47. The 3-and 5-year overall survival (OS) was 98％ and 90％.The 3-and 5-year cancer-specific survival (CSS) was 100％ and 93％.The 3-and 5-year biochemical relapse-free survival was 97％ and 86％. The mean time of PSA declining to the nadir was 5. 83 months. The median level of PSA nadir was 0. 06 ng/ml after IMRT. The incidence of grade I andⅡearly adverse events in the urinary system was 38％ and 6％. The incidence of grade I andⅡearly adverse events in the gastrointestinal system was 21％ and 3％. The incidence of grade I andⅡadvanced-stage adverse events in the urinary system was 9％ and 2％. The incidence of grade I advanced-stage adverse events in the gastrointestinal system was 5％. Conclusions IMRT yields high clinical efficacy in the treatment of intermediate risk localized prostate cancer with a low risk of adverse events in the early and advanced stage. The monitoring of PSA after IMRT contributes to the assessment of clinical prognosis.%目的 分析局限期中危前列腺癌IMRT疗效和不良反应,分析PSA变化水平和意义.方法 回顾分析2007—2018年间经本院IMRT局限期中危前列腺癌66例资料.60例放疗前接受内分泌治疗,6例照射野包括盆腔淋巴引流区,47例采用IGRT技术.前列腺精囊腺中位剂量78 Gy,盆腔淋巴引流区中位剂量48 Gy.采用Kaplan-Meier法计算生存率.结果 中位年龄77岁,中位随访时间71.3个月.5年样本量47例.3、5年OS率分别为98％、90％,CSS率分别为100％、93％,BRFS率分别为97％、86％.PSA降至最低点的平均时间为5.83个月.IMRT后PSA最低点中位数为0.06 ng/ml.1、2级早期泌尿系统不良反应发生率分别为38％、6％,1、2级早期直肠不良反应发生率分别为21％、3％,1、2级晚期泌尿系统不良反应发生率分别为9％、2％,1级晚期直肠不良反应发生率为5％.结论 局限期中危前列腺癌IMRT疗效好,早期、晚期不良反应小,IMRT后PSA监测利于判断肿瘤预后.