前列腺癌三维适形放疗联合内分泌治疗疗效观察

近年来,我国前列腺癌发病率呈上升趋势.前列腺癌常见于老年人,常在诊断后因身体状况不佳或内科疾病不能手术或不宜手术,放疗成为主要治疗手段.常规放疗由于受到放疗技术和肿瘤周围正常组织限制,放疗剂量提高困难,直肠、膀胱副反应重~([1]).本研究回顾分析39例前列腺癌的三维适形放疗疗效及副反应.     

前列腺癌的放射治疗

放疗是前列腺癌的重要治疗手段之一，早期前列腺癌放疗可达到根治目的；局部晚期前列腺癌的治疗则采取放疗为主结合内分泌手段的治疗方法；已远处转移的前列腺癌放疗也可取得减轻症状、改善生存质量的目的。文章就前列腺癌放疗方面的相关问题进行综述。     

前列腺癌放射治疗及PSA监测价值的探讨

目的探讨前列腺癌放射治疗及放疗前后PSA测定的预后判断价值.方法 10例前列腺癌分别行单纯前列腺切除及双侧睾丸去势术,术后均给予8MV-X线放射治疗及放疗前后PSA测定.结果疗后前列腺肿瘤及盆腔转移灶全部缩小及消退.化疗后PSA下降者生存期长,升高者生存期短.结论前列腺癌根治术、放射治疗及内分泌治疗等综合治疗是前列腺癌有效的治疗方法.术后放疗能提高生存率.PSA测定可作为治疗失败或复发及远处转移的指标.     

根治性前列腺癌低分割放疗的研究进展

放疗是局限性前列腺癌的重要治疗手段之一,既往根治性放疗为常规分割模式。近年来低分割放疗技术在根治性前列腺癌中的应用得到了快速发展,中等低分割放疗已被认为在有条件的单位可作为常规分割模式的替代方式,超低分割放疗(也称为立体定向放疗)在低中危患者中也有越来越多的证据。但高危前列腺癌的立体定向放疗的有效性及安全性还未得到充分...     

“前列腺癌靶区勾画”专题研讨会简介

由中华医学会北京分会放射肿瘤专业委员会主办，中国医学科学院肿瘤医院放疗科承办的2006年第1季度学术活动于2006年4月28日在中国医学科学院肿瘤医院举行。来自北京各医院的200多名放疗医生、物理师和技师参加了会议。会议重点讨论了前列腺癌的靶区勾画，此外，北京协和医院张福泉教授介绍了超声引导下前列腺癌的放射治疗，中国医学科学院肿瘤医院李哗雄教授阐述了前列腺癌放射治疗的靶区勾画原则，王维虎教授就前列腺癌的重碳离子放疗计划和调强放疗计划作了比较，房辉博士报道了中国医学科学院肿瘤医院最近几年前列腺癌适形放疗和调强放疗的初步疗效。     

前列腺癌放疗直肠防护技术研究进展

放射治疗是前列腺癌的重要治疗手段, 前列腺与直肠关系密切, 直肠防护至关重要。近年来, 直肠防护技术层出不穷, 本文对前列腺癌放疗中直肠防护技术进行了系统综述, 包括放疗技术改进、图像引导、直肠球囊扩张、直肠隔离凝胶的使用等对直肠的防护作用, 为临床提高前列腺癌放疗安全, 降低直肠放射损伤提供参考。     

多学科综合治疗——改善高危前列腺癌患者的预后

手术和放疗是局限性前列腺癌主要的治疗方法,但对于高危前列腺癌单用局部治疗预后不佳,超过50％的患者会复发。手术、放疗、内分泌治疗和化疗的联合应用目前被认为是提高高危前列腺癌疗效的重要途径。本文总结了目前高危前列腺癌综合治疗的相关文献,期望能为我国高危前列腺癌综合治疗方案的选择提供借鉴和参考。     

37例前列腺癌三维适形放疗的预后分析

目的分析前列腺癌三维适形放疗的疗效及预后因素.方法 对37例前列腺癌患者进行三维适形放疗,24例行三维适形放疗前接受双侧睾丸切除,4例行放疗去势.20例同时服用艾去适内分泌化疗药物9～12个月.采用三维适形放疗技术照射前列腺靶区,5次/周,2 Gy/次.肿瘤中位剂量72 Gy（60～76 Gy）.用Longrank进行单因素,Cox进行多因素分析.结果 中位随访27个月（6～107个月）,随访率为95%.3、5年生存率分别为80%、70%.单因素分析显示年龄、治疗前PSA水平、有无区域淋巴结转移、是否合并远处转移、靶区照射剂量及是否采用综合治疗对生存期有影响.多因素分析显示治疗前PSA水平、靶区照射剂量及是否采取综合治疗3个因素影响预后.结论 前列腺癌三维适形放疗安全有效,治疗前PSA水平、靶区照射剂量及是否采取综合治疗是预后的影响因素.     

关于前列腺癌放疗敏感性的差异基因及生物学功能的分析:基于GEO数据库

目的:采用生物信息学的方法探讨影响前列腺癌放疗敏感性的差异基因表达及其生物学功能富集与疾病预后的潜在关系.方法:检索并获取GE O数据库中的关于前列腺癌放疗敏感性差异基因表达的数据(GSM3954350、GSM3954351、GSM3954352),GER2工具对差异基因进行筛选和分析,采用Enrichr数据库进行GO...     

前列腺癌患者治疗前后PSA水平

目的　探讨PSA在前列腺癌临床诊疗中的应用价值。方法　采用ELISA法测定 3 3例健康者、3 6例良性前列腺增生及 3 3例前列腺癌治疗前后T PSA和F PSA并动态观察 2 0例放疗后T PSA水平变化。结果　前列腺癌T PSA和F PSA、F/T均显著高于良性前列腺增生 (P <0 .0 1) ;前列腺癌治疗后T PSA和F PSA显著下降 (P <0 .0 1) ,而F/T无明显改变 (P >0 .0 5 ) ;前列腺癌放疗后病情稳定T PSA下降 ,病情进展则T PSA升高。结论　动态测定前列腺癌患者治疗前后PSA水平变化 ,可判断近期疗效 ,监测病情变化。     

Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2010 consensus guidelines for definitive external beam radiotherapy for prostate carcinoma

External beam radiotherapy for prostate cancer has undergone substantial technological and clinical advances in the recent years. The Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group undertook a process to develop consensus clinical practice guidelines for external beam radiotherapy for prostate carcinoma delivered with curative intent, aiming to provide guidance for clinicians on the appropriate integration of clinical evidence and newer technologies. Draft guidelines were presented and discussed at a consensus workshop in May 2009 attended by radiation oncologists, radiation therapists and medical physicists. Amended guidelines were distributed to radiation oncologists in Australia, New Zealand and Singapore for comment, and modifications were incorporated where appropriate. Evidence based recommendations for risk stratification, the role of image-guided and intensity-modulated radiation therapy, prescribed dose, simulation and treatment planning, the role and duration of neo-adjuvant/adjuvant androgen deprivation therapy and outcome reporting are presented. Central to the guidelines is the recommendation that image-guided radiation therapy should be used when definitive external beam radiotherapy for prostate cancer is prescribed. The consensus guidelines provide a co-operatively developed, evidence-based framework for contemporary treatment of prostate cancer with external beam radiotherapy.     

Advancement of treatment for prostate cancer

The number of prostate cancer patients is rapidly increasing in Japan, as aging people are more common and the lifestyle is more westernized. Another reason is that prostate specific antigen (PSA) is prevalent and PSA test can detect organ-confined prostate cancer in the early stage. In the past, endocrine therapy was the main treatment modality since many prostate cancer patients were diagnosed in the advanced stage. However, endocrine therapy is not suitable for young patients with organ-confined prostate cancer. Surgery and radiation therapy are becoming standard therapy for these patients. Although retropubic radical prostatectomy is widely performed,urinary incontinence and sexual dysfunction are still problems. Other approaches such as laparoscopic prostatectomy, portless endoscopic prostatectomy and perineal prostatectomy are also performed. Radiation therapy is commonly used for organ-confined prostate cancer in Europe and the U.S.A. The advancement in computer technology has made it possible to accumulate enough radiation dose to target without damaging the surrounding organs (3 D conformal, intensity-modulated radiotherapy). Heavy ion particle radiotherapy is also attempted in some institutes. Moreover, brachytherapy can be another choice in radiation therapy. In Japan, only high-dose brachytherapy with (192)Ir has been performed. In July 2003, permanent seed brachytherapy with (121)I was legally approved in Japan, and more organ-confined prostate cancer patients are expected to undergo this treatment. There are several treatment modalities for organ-confined prostate cancer patients these days. Therefore, not only tumor grade and stage, but also patients'lifestyle and thought should be considered in determining treatment.     

Radical radiotherapy for prostate cancer

External beam radiotherapy is one of the curative treatment options for localised prostate cancer. This article will describe recent advances in prostate radiotherapy, focussing on the results of randomised trials which have addressed the role of radiation dose escalation and of adjuvant hormone therapy. Current controversies will then be considered, including the merits of radiotherapy in comparison with alternative approaches to early prostate cancer, and the possible role of adjuvant radiation following surgery. Finally, future developments will be described, including hypofractionation and dose individualisation, which have the potential to further improve the outcome of external beam radiotherapy for prostate cancer.     

Combining radiotherapy with gene therapy (from the bench to the bedside): a novel treatment strategy for prostate cancer

Combined radiotherapy and gene therapy is a novel therapeutic approach for prostate cancer. There are various potential benefits in combining ionizing radiation with gene therapy to achieve enhanced antitumor effects: A) ionizing radiation improves transfection/ transduction efficiency, transgene integration, and possibly, the "bystander effect" of gene therapy; B) gene therapy, on the other hand, may interfere with repair of radiation-induced DNA damage and increase DNA susceptibility to radiation damage in cancer cells, and C) radiotherapy and gene therapy target at different parts of the cell cycle. Preclinical data have demonstrated the enhanced antitumor effects of this combined approach in local tumor control, prolongation of survival, as well as systemic control. This combined radio-gene therapy is under study in an ongoing clinical trial in prostate cancer. Our study adds gene therapy to the standard of care therapy (radiotherapy). These treatment modalities have different toxicity profiles. The goal of this combined approach is to enhance cancer cure without an increase in treatment-related toxicity. This approach also offers a new paradigm in spatial cooperation, whereby two local therapies are combined to elicit both local and systemic effects. Early clinical results showed the safety of this approach.     

Short-term androgen deprivation therapy for patients with intermediate-risk prostate cancer undergoing dose-escalated radiotherapy: the standard of care?

What is the best way to manage patients with intermediate-risk prostate cancer? One of the most controversial aspects of treatment is the role of short-term androgen deprivation therapy in combination with definitive radiotherapy. In two randomised trials of patients with mostly intermediate-risk prostate cancer, increased overall survival was reported when short-term androgen deprivation therapy was added to radiotherapy. However, radiation doses in these studies were far below the current standard of care. This limitation, in combination with the heterogeneous nature of the cancers classified as intermediate risk, has complicated the application of these trial results to modern clinical practice. In this Review, we discuss clinical evidence for and against use of short-term androgen deprivation therapy with dose-escalated radiotherapy for patients with intermediate-risk prostate cancer.     

放射物理学及分子放射生物学在临床放疗实践中的应用和未来发展

最近几年,放射物理学和分子放射生物学的进步促进了放射肿瘤学的显著发展.目前,我们从常规的二维放疗到三维适形放疗,已进入了调强放疗(intensity-modulated radiotherapy,IMRT)和影像引导放疗(image-guided radiotherapy,IGRT)的时代.IMRT/IGRT可对肿瘤组织进行适形治疗,对正常组织适形地避免照射,从而改善肿瘤控制并减少治疗相关的放射损伤.目前无框架立体定向放射手术(stereotactic radiosurgery,SRS)和立体定向体部放疗(stereotactic body radiotherapy,SBRT)已进入临床应用,这为放射肿瘤临床提供了更多的治疗选择.随着影像引导技术的进步,近距离放疗得到了发展,尤其是应用于早期前列腺癌,获得了非常满意的长期疗效.带电粒子治疗,包括质子疗法是新开发的充满前景的领域.放疗与传统化疗、激素疗法、新的靶向治疗和基因疗法联合使用为克服放疗抗拒、改善放疗指数提供了更好的局部-区域和全身癌症控制效果.最近进行的一项关于头颈部癌的随机临床试验表明,与单纯放疗相比,放疗联合靶向治疗可以提高患者生存率,而在功能或分子影像学方面取得的进步为提高人们对肿瘤靶区的认识提供了新的机会(例如乏氧区),并可进行对应放射剂量的调强治疗.在放疗中整合PET/CT可在治疗计划测定中有助于进行靶区勾画和对放疗反应的评估.放射抗拒相关的肿瘤干细胞、基因表达图谱分析以及毫微秒技术也是新进展的领域,随着个体化用药的发展,正在作进一步研究.     

Chemotherapy and radiotherapy for urological cancer

Prostate cancer, bladder cancer, renal cancer and testicular cancer are common among urological cancers. The treatment strategy for testicular cancer using chemotherapy has been well established and has been shown to be successful. Chemotherapy and radiotherapy play important roles in multidisciplinary therapy for bladder cancer. Radiotherapy is often used as a radical treatment that is practically equivalent to surgery for prostate cancer. In addition, radiotherapy is useful in cases of bone or brain metastases. In the field of chemotherapy, the development of new agents that would make breakthroughs similar to that of cisplatin is awaited. Taxanes and gemcitabine are good candidates. In the field of radiotherapy, 3D conformal radiation therapy (CRT), which has excellent beam distribution, has recently come into wide use. Moreover, brachytherapy and proton and ion beam therapy are expected to prove useful in prostate cancer therapy.     

Radiation therapy in prostate cancer: a risk-adapted strategy

External-beam radiotherapy and brachytherapy, widely utilized as curative treatment modalities for prostate cancer, have undergone significant clinical and technological advances in recent decades. Contemporary radiotherapy treatment algorithms use pretreatment prognostic factors to stratify patients into low-, intermediate-, and high-risk groups that correlate with both pathologic stage of disease and risk of recurrence after treatment. The use of risk groups and additional prognostic factors guide selection of the optimal treatment modalities for individual patients. Here, the roles of external-beam radiotherapy, brachytherapy, and neoadjuvant or adjuvant androgen deprivation therapy are discussed in that context. Additional prognostic factors for recurrence in the post-prostatectomy setting and the role of adjuvant and salvage radiation therapy are also reviewed. The risk-adaptive approach in radiotherapy for prostate cancer aims to optimize cancer control outcomes while minimizing the morbidity of treatment.     

Innovations thérapeutiques en radiothérapie du cancer de la prostate localisé

Intensity-modulated radiation therapy, image-guided radiation therapy with fiducial markers and prostate brachytherapy allow the delivery of dose escalation for localized prostate cancer with very low rates of long-term toxicity and sequelae. Nowadays, modern radiotherapy techniques make it possible to shorten treatment time with hypofractionation, to better protect surrounding healthy tissues and to escalate the dose even further. Advances in radiotherapy are closely linked to advances in magnetic resonance imaging (MRI) and/or PET imaging. Functional imaging makes it possible to deliver personalised pelvic nodal radiotherapy, targeting the nodal areas at higher risk of microscopic involvement. In patients with an index lesion at baseline or at failure, MR-based focal therapy or focal dose escalation with brachytherapy or stereotactic body radiation therapy is also currently investigated. MR-based adaptive radiotherapy, which makes it possible to track prostate shifts during radiation delivery, is another step forward in the integration of MR imaging in radiation delivery.     

同期放疗联合内分泌治疗对中晚期前列腺癌患者生存质量的影响

目的 探讨同期放疗联合内分泌治疗对中晚期前列腺癌患者生存质量的影响.方法 选取中晚期前列腺癌患者82例,依据治疗方式的不同分为对照组(n=41)和研究组(n=41).对照组行三维适形放射治疗,研究组行同期放射治疗联合内分泌治疗(口服比卡鲁胺50 mg,每天1次,皮下注射戈舍瑞林3.6 mg,每28 d 1次,持续3年).比较两组患者放疗前和放疗后3年的最大尿流率、前列腺癌症状评分表(EPIC)评分及并发症发生情况.结果 放疗后3年,研究组和对照组患者的最大尿流率分别为(13.67±1.68)ml/s和(11.03±0.98)ml/s,差异有统计学意义(P﹤0.05);研究组患者的EPIC评分高于对照组(P﹤0.05);研究组和对照组患者在治疗期间的并发症总发生率分别为41.5%和70.7%,差异有统计学意义(P﹤0.05).结论 同期放疗联合内分泌治疗能够改善中晚期前列腺癌患者的生理功能状况,减少不良反应,提高患者的生存质量,具有重要的临床应用价值.