前列腺癌根治术后IGRT疗效分析

摘要

Objective To analyze the clinical efficacy and toxicity of adjuvant (ART) and salvage radiotherapy (SRT) after prostatectomy for prostate careinoma,and to investigate the variation and significance of prostate-specific antigen (PSA) level.Methods A retrospective study was performed on the clinical data of 58 patients receiving intensity-modulated radiotherapy after prostatectomy from November 2008 to August 2015.In those patients,21 received ART and 37 SRT.The median dose delivered to the 95％ planning target volume (PTV) of the prostate and seminal vesicles tumor bed was 74 Gy,and 95％ PTV of the pelvic lymph nodes was 50 Gy.The survival rate was calculated by Kaplan-Meier method.Used Pearson correlation analysis.Results The median follow-up time was 36.2 months.The 3-year biochemical relapse-free survival,tumor-specific survival,and overall survival rates were 81.8％,100％,and 96％,respectively.In all patients,the median time to PSA nadir after radiotherapy was 3 months with a mean level of PSA nadir of 0.04 ng/ml.In patients treated with ART,the median PSA level before radiotherapy was 0.034 ng/ml;the median time from surgery to radiotherapy was 5.4 months;the mean time to PSA nadir after radiotherapy was 4.6 months.In patients treated with SRT,the median PSA level before radiotherapy was 0.540 ng/ml;the median time from surgery to radiotherapy was 69.7 months;the mean time to PSA nadir after radiotherapy was 9.4 months.The incidence rates of grade 1 and 2 short-term genitourinary (GU)toxicity were 55％ and 2％,respectively,while the incidence rates of grade 1 and 2 long-term GU toxicity were 10％ and 16％,respectively.The incidence rates of grade 1 and 2 short-term gastrointestinal (GI)toxicity were 30％ and 8％,respectively,while the incidence rates of grade 1 and 2 long-term GI toxicity were 9％ and 3％,respectively.No patients had grade 3 or 4 toxicity.Rectum D50 was significantly related with acute and late GI side effects (P=0.012、0.026).Conclusions Both ART and SRT achieve satisfactory treatment outcomes and low short-and long-term toxicity.Compared with ART,SRT has a longer time to PSA nadir.%目的 分析前列腺癌根治术后辅助性及挽救性放疗的临床疗效、不良反应,同时对PSA变化水平和意义进行分析.方法 回顾分析2008-2015年间收治的前列腺癌根治术后行放疗患者58例资料(IGRT 50例,IMRT 8例),辅助性放疗21例,挽救性放疗37例.前列腺精囊95％ PTV中位处方剂量为74 Gy,盆腔95％PTV中位处方剂量为50 Gy.Kaplan-Meier方法计算生存率,Pearson法行相关分析.结果 中位随访36.2个月.3年BRFS率为82％,3年OS率为96％.全组PSA放疗后降至最低点的中位时间为3个月,平均值为0.04 ng/ml.辅助性放疗前PSA中位数0.034 ng/ml,手术至放疗中位时间5.4个月,放疗后PSA降至最低点平均需4.6个月.挽救性放疗前PSA中位数0.540 ng/ml,手术至放疗中位时间69.7个月,放疗后PSA降至最低点平均需9.4个月.1、2级急性泌尿生殖和胃肠道反应发生率分别为55％、2％和30％、8％;1、2级晚期泌尿生殖和胃肠道反应发生率分别为10％、16％和9％、3％.直肠D50与早晚期胃肠道反应发生率明显相关(P=0.012、0.026).结论 辅助性放疗比挽救性放疗PSA降至最低点时间短,二者早期晚期不良反应小.