目的 回顾分析老年前列腺癌患者根治术后接受调强技术放疗疗效和不良反应.方法 2007-2017年收治98例接受术后放疗的前列腺癌患者,中位年龄68岁.全组患者中低危10例、中危21例、高危67例.2例患者存在寡转移(均为骨盆骨转移),64例患者联合了内分泌治疗.全组患者中43例接受辅助放疗,55例接受挽救放疗.放疗均采用了调强技术(55例调强放疗、43例容积调强弧形治疗),前列腺瘤床中位剂量72 Gy.共29例接受了盆腔淋巴结区域照射,中位放疗剂量50 Gy.结果 中位随访40个月,全组5年总生存率、无生化复发生存率、局部控制率分别为90％、76％、100％.辅助放疗和挽救放疗的总生存率、无生化复发生存率、局部控制率均相近[89％和91％(P=0.94)、76％和71％(P=0.79)、100％和100％ (P=0.32)].不良反应方面1-2级晚期直肠反应发生率为24.1％,1-2级晚期膀胱反应发生率为29.9％,3级为3.4％.结论 前列腺癌根治术后采用调强技术放疗可以获得很好的疗效,晚期不良反应轻微.%Objective To evaluate the clinical efficacy and toxicity of intensity-modulated radiation therapy (IMRT) following prostatectomy for elderly patients with prostate cancer.Methods Ninety-eight prostate cancer patients receiving IMRT after prostatectomy were included in this study.The median age was 68 years old.The number of patients with low-,middle-and high-risk prostate cancer was 10,21 and 67,respectively.Two patients had oligometastases (pelvic bone metastases).Sixty-four patients were treated with IMRT combined with endocrine therapy.Among them,43 cases received adjuvant volumetric modulated arc therapy (VMAT),and 55 patients received salvage IMRT.The median radiotherapy dose was 72 Gy for the tumor bed.Twenty-nine patients received radiotherapy of the pelvic node region with a median dose of 50 Gy.Results The median follow-up time was 40 months.The 5-year overall survival (OS),biochemical recurrence-free survival (BRFS) and local control (LC) were 90％,76％ and 100％,respectively.The OS (88.8％ vs.90.8％,P=0.94),BRFS (75.9％ vs.71％,P=0.79) or LC (100％ vs.100％,P=0.32) did not significantly differ between the adjuvant and salvage radiotherapy groups,respectively.The incidence of grade Ⅰ-Ⅱ late rectal toxicities was 24.1％,and no ≥ grade 3 late toxicity was observed.The incidence of grade 1-2 late bladder toxicities was 29.9％,and 3.4％ for grade 3.Conclusion IMRT following prostatectomy yields high clinical efficacy and slight late toxicities in elderly patients with prostate cancer.
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