调强放疗联合内分泌治疗中晚期前列腺癌42例临床分析

目的 分析调强放射治疗(IMRT)联合内分泌治疗对中晚期前列腺癌的短期治疗效果和副反应.方法 回顾性分析IMRT联合内分泌治疗中晚期前列腺癌42例患者的临床资料.放疗采用IMRT技术,1.8～2.0 Gy/次,5次/周,总放射量(DT)64 ～78 Gy,平均70.4 Gy.内分泌治疗采用去势同时加比卡鲁胺抗雄激素治疗的联合雄激素阻断治疗,28例放射治疗前接受手术去势,14例应用戈舍瑞林或亮丙瑞林药物去势.结果 42例均完成放射治疗,36例患者治疗6个月后血清PSA降至1ng/mL以下,放疗结束后尿频、排尿困难、里急后重等症状均有不同程度改善.1、2、3级急性胃肠道反应发生率分别为33.3％(14例)、9.5％(4例)、4.8％(2例),1、2级急性泌尿生殖系统反应发生率为38.1％(16例)、9.5％(4例).结论 IMRT联合内分泌治疗中晚期前列腺癌疗效满意,副反应发生率较低,是前列腺癌治疗的有效手段.     

三维适形放疗加内分泌治疗中晚期前列腺癌32例临床分析

目的分析三维适形放射治疗（3D-CRT）联合内分泌治疗对中晚期前列腺癌的治疗效果。方法回顾性分析3D-CRT联合内分泌治疗中晚期前列腺癌32例的临床资料。内分泌治疗采用去势加抗雄激素治疗的联合雄激素阻断治疗，26例放射治疗前接受双侧睾丸切除，1例行睾丸放疗去势，5例应用抑那通药物去势。抗雄激素治疗药物应用氟他胺，与去势治疗同时应用。放疗采用3D-CRT技术，1．8～2．0Gy／次，5次／周，肿瘤量（DT）68～72Gy，平均剂量70Gy。结果1例治疗过程中突发心肌梗死死亡，31例完成放射治疗。放疗结束后31例患者排尿困难等症状均不同程度改善，25例患者治疗6个月后血清PSA降至正常。平均随访30个月（6～75个月），3、5年生存率分别为80．6％和69．1％，5年肿瘤特异生存率为80．4％，1、2、3级急性胃肠道反应发生率分别为43．7％、6．3％、3．1％，1、2级急性泌尿生殖系统反应发生率分别为34．4％、6．3％。结论3D-CRT联合内分泌治疗前列腺癌疗效满意，副反应小，是中晚期前列腺癌综合治疗的有效手段。     

前列腺癌根治术后的盆腔照射放疗不会影响尿失禁的恢复

目的探讨前列腺癌根治术后盆腔照射放疗对患者尿失禁恢复及排尿功能的影响。方法自2012年3月至2016年7月,共纳入28例行前列腺癌根治术及术后辅助调强放疗的患者。其中17例于术后接受单纯瘤床区的调强放疗(单纯瘤床组),中位放疗剂量为72 Gy (64～74 Gy);11例接受瘤床联合盆腔淋巴引流区的调强放疗(联合组)。瘤床和盆腔淋巴引流区的中位照射剂量分别为70 Gy (50～74 Gy)和50 Gy (24～55 Gy)。在术后2个月及放疗后2、6、12、18、24、36个月使用扩大前列腺癌指数(EPCI)工具的排尿部分对患者的尿失禁恢复情况及排尿功能进行前瞻式的随访。最后比较两组患者尿失禁的恢复情况及排尿功能的差异。结果两种放疗范围下对应的术后尿失禁恢复情况无统计学差异(P=0.454)。单纯瘤床组和联合组在放疗前使用EPCI工具所测得的基线排尿功能评分分别为39.76±9.88、38.09±7.74;放疗2年后分别测得为37.82±9.18、37.18±8.05,各组放疗前与放疗后的排尿功能无统计学差异(P=0.851)。联合组放疗过程中白细胞降低的发生率显著上升(P=0.023)。结论前列腺癌根治术后瘤床联合盆腔淋巴结引流区调强放疗与单纯瘤床调强放疗相比,不会影响术后尿失禁的恢复且不会降低术后排尿功能。但前者在放疗过程中可能会增加白细胞减低的风险。     

动态调强放疗和螺旋断层放疗对盆腔肿瘤的影响：一项前瞻性剂量测定的研究

对于患盆腔肿瘤且接受淋巴结照射的患者,为了比较其动态调强放疗（IMRT）的剂量测定结果,Servagi-Vernat等人将51例患者纳入前瞻性研究。其中36例患有高危前列腺癌的患者接受治疗（13例接受螺旋断层放疗,23例接受动态调强放疗）,15例患有局部肛管癌的患者接受治疗（9例接受螺旋断层放疗,6例接受动态调强放疗）。根据计划靶区覆盖度的不同评估两种治疗方案的效果。     

转移性前列腺癌患者一例综合诊治报道并文献复习

目的探讨转移性前列腺癌不同诊断治疗手段的选择和时机。 方法回顾性分析1例转移性前列腺癌患者的临床资料，复习相关文献并予以讨论。患者，男，65岁，因"耻骨区疼痛伴尿频3月"入院。血PSA>1 000 μg/L。前列腺穿刺活检：双侧均为前列腺腺癌，Gleason评分8分（4+4），临床分期T4N0M1b。 结果患者接受了去势+比卡鲁胺治疗17个月后进展为去势抵抗性前列腺癌，阿比特龙治疗原发耐药，行基因检测后接受了盆腔放疗和多西他赛化疗，随后病情缓解。 结论对于转移性前列腺癌患者，内分泌治疗是综合治疗的基石，局部放疗和多西他赛化疗有利于缓解临床症状和延长患者生存期，基因检测对个体化治疗方案的制定有一定指导价值。     

减小非小细胞肺癌三维适形放射治疗靶体积可行性剂量学研究

目的从剂量学探讨减小非小细胞肺癌三维适形放射治疗照射体积的可行性。方法32例非小细胞肺癌患者均做2个放射治疗计划：常规照射野三维适形放射治疗计划和小野三维适形放射治疗计划,用剂量体积直方图评估肿瘤靶区剂量和正常组织受照剂量。结果小野三维适形放射治疗仍能满足肿瘤靶区剂量的要求,亚临床灶的最小剂量、最大剂量和平均剂量分别为50．93Gy、54．60Gy和（52．37±1．02）Gy。与常规适形野相比,小野适形放疗减少了患侧肺、脊髓和食管的平均剂量（P〈0．05）。结论缩小非小细胞肺癌三维适形放射治疗照射野能满足肿瘤靶区剂量的需要,同时降低了正常组织的受照剂量,可在临床开展相关研究。     

三维适形放射治疗联合替吉奥化学治疗局部复发性直肠癌32例

目的观察三维适形放射治疗(放疗)联合替吉奥化学治疗(化疗)局部复发直肠癌的安全性与可行性。方法32例经证实的局部复发直肠癌患者接受全盆腔三维适形放疗DT45Gy/25F,后缩野至肿瘤复发区推量至63Gy/35F,同期口服替吉奥胶囊80 mg·(m2)-1·d-1(d1～5,d8～12,d15～19,d22～26,d29～33,d36～40,d43～47)。结果有1例患者口服替吉奥胶囊1周后出现4级血小板下降,停用化疗,只完成放疗,其他患者均完成放疗和化疗。32例患者中,完全缓解3例(9.4%),部分缓解21例(65.6%),总有效率为75.0%;1和2年生存率分别为71.0%和56.5%;疼痛缓解率为96.9%。主要毒性反应为消化道反应和血液学毒性,有1例出现4级血小板下降,有2例出现3级白细胞下降,有1例出现3级腹泻,3～4级毒性反应发生率为12.5%。结论三维适形放疗联合替吉奥化疗治疗局部复发性直肠癌方法,近期疗效可靠,患者依从性好,毒性反应可耐受。     

50例晚期胰腺癌三维适形放疗的近期疗效分析

目的 分析三维适形放疗治疗晚期胰腺癌的疗效及相关预后因素.方法 50例不能手术的晚期胰腺癌病人,采用常规分割的三维适形放疗;其中14例采用姑息性放疗(A组),给予10.8～56 Gy;27例采用单一三维适形放疗(B组),剂量范围为8～60.5 Gy;9例采用同步放化疗的方法(C组),剂量范围为10～64 Gy.同步放化疗中化疗采用吉西他滨(200～600 mg/m~2,1次/周).结果 随访时间为3～35个月,死亡43例,死亡原因主要为肝脏和(或)腹腔内的广泛转移、恶液质、继发感染和出血.存活7例中3例为同步放化疗,3例为单一放疗,1例为姑息治疗.A组存活1人,放疗后局部症状缓解率46%(6/13),平均生存时间5.07个月;其中放疗剂量小于45 Gy的病人有10例,平均存活时间为4.33个月;放疗剂量≥45 Gy者3例,平均存活时间为7.33个月.B组存活3例,治疗后疼痛缓解率为81%(22/27),平均存活6.65个月,其中放疗剂量小于45 Gy的有11例,平均存活时间为4.36个月;放疗剂量≥45 Gy者16例,平均存活时间为8.33个月.C组存活3例,治疗后疼痛缓解率为89%(8/9),放疔后平均存活9.89个月,其中放疗剂量小于45 Gy的有1例,存活时间为3个月;放疗剂量≥45 Gy者8例,平均存活时间为10.73个月.结论 三维适形放疗对晚期胰腺癌有姑息治疗的作用,疗效与治疗方式的选择、放疗剂量、病变累及范围和病人一般状态密切相关.对于部分晚期胰腺癌病人,采用积极同步放化三维适形放疗可获得较长的生存时间.     

PSMA-SPECT/CT在前列腺癌转移病灶精准治疗中的价值

目的:进一步提高前列腺癌转移灶的诊断以及治疗水平。方法:收集2015~2016年我院收治并接受前列腺特异性膜抗原(PSMA)-单光子发射计算机断层摄影术联合同机CT扫描图像融合技术(SPECT/CT)检查的前列腺癌患者,对其中3例典型患者的临床资料进行回顾性分析。结果:病例1予以内分泌治疗后,PSA控制效果不佳,PSMA-SPECT/CT明确右盆腔淋巴结转移病灶后行前列腺癌根治术+盆腔扩大淋巴结清扫术,术后病理结果同影像学检查效果一致,术后PSA明显下降。病例2行前列腺癌根治术后,PSA控制效果不佳,加用盆腔放疗后未见明显降低,PSMA-SPECT/CT示腹膜后淋巴结转移,遂行腹膜后淋巴结清扫术,术后病理结果同PSMA-SPECT/CT检查结果一致,术后PSA水平下降。病例3行前列腺根治术后,PSA控制不佳,PSMASPECT/CT示右髂内淋巴结转移,根据PSMA-SPECT/CT行靶病灶放疗,PSA水平明显下降。结论:该研究提示99mTC-PSMA-SPECT/CT与目前影像学检查比较,能够更好地发现前列腺癌转移灶,且精准指导靶病灶治疗,进而使患者获益。     

TVP后睾丸切除和缓退瘤治疗合并尿潴留的晚期前列腺癌10例体会

我院1998年10月以来,对10例合并尿潴留的晚期前列腺癌患者在行经尿道前列腺电气化术(TVP)后再行双侧睾丸切除(去势术)和口服缓退瘤治疗,取得较好效果,报告如下。临床资料1.一般资料:本组10例,年龄59~81岁,平均69岁。均合并尿潴留,其中4例于外院行膀胱造瘘。直肠指检,7例表现为前列腺弥漫性增大,3例单侧叶增大,质硬如石,边界不清,散在结节,固定。彩超检查5例提示前列腺癌,2例经CT诊断,3例MRI诊断,PSA均高于正常。骨转移6例,盆腔淋巴结转移2例,左下肢水肿1例,左腹股沟淋巴结转移1例。4例双肾积水并伴血尿素氮、肌酐升高,1例左肾积水。2.…     

Comparison of late gastrointestinal and genitourinary toxicity of prostate cancer patients undergoing intensity-modulated versus conventional radiotherapy using localized fields

To compare late genitourinary (GU) and gastrointestinal (GI) toxicity of radiotherapy (RT) to localized fields for prostate cancer delivered using intensity-modulated RT (IMRT) versus conventional RT (ConvRT). The records of 461 patients were reviewed; 355 patients received IMRT and 106 received ConvRT. Late GU and GI toxicity were compared. Late GU toxicity rates were not significantly different (P=0.166); however, late GI toxicity rates were lower with IMRT (P=0.001). Regression analyses demonstrated that only IMRT use (P=0.006) predicted reduction in late GI toxicity but no factors correlated with late GU toxicity. IMRT did not influence late GU toxicity but was associated with a reduction of late GI toxicity over ConvRT.     

Pretreatment prostate specific antigen (PSA) and 2-year PSA dynamics: Early predictors of prostate cancer prognosis with external radiation therapy

IntroductionThe dynamics of prostate specific antigen (PSA) in patients who have prostate cancer and receive radiotherapy is a very interesting but complicated topic. We tried to plot the sequential changes of PSA with and without hormone therapy and tried to find out the predictors for the high-risk patients for prostate cancer recurrence.MethodsWe reviewed the medical records of 164 prostate cancer patients who underwent intensity-modulated radiation therapy (IMRT) as the primary treatment. We recorded the patients' age, initial PSA, cancer grading at diagnostic biopsies (Gleason's score), clinical stage, the IMRT dosage, neoadjuvant, concomitant, and prolonged hormone therapy, follow-up PSA levels, biochemical progression, and distant metastasis.ResultsOf the 84 patients undergoing radiotherapy for prostate cancer with complete data for analysis, the biochemical failure-free survival (BFFS) rate was 88.09%. The patients with an initial PSA of less than 10 ng/mL had the best BFFS. Of the patients receiving neoadjuvant hormone therapy (NHT), serum PSA levels were significantly higher in those with biochemical failure than those without biochemical failure in the 3 months after radiation therapy. As for the patients free of biochemical failure, the mean PSA fell below 1 ng/mL immediately after IMRT for the NHT(+) group and at 9 months after IMRT for the NHT(–) group.ConclusionFor the patients with localized prostate cancer who underwent IMRT, initial PSA could predict clinical stage, 1-year BFFS, and 2-year BFFS. The follow-up PSA, as early as 3 months, was of clinical predictive value.     

Long-term followup of a randomized study of locally advanced prostate cancer treated with combined orchiectomy and external radiotherapy versus radiotherapy alone

PURPOSE: In a randomized study we compared the combination of orchiectomy and radiotherapy to radiotherapy alone as treatment for locally advanced prostate cancer. Patients who were treated only with radiotherapy initially underwent castration therapy at clinical progression, providing the opportunity to compare immediate vs deferred endocrine intervention. MATERIALS AND METHODS: In this prospective study 91 patients with locally advanced prostate cancer were randomized to receive external beam radiotherapy (46) or combined orchiectomy and radiotherapy (45) after surgical lymph node staging. Survival rates were calculated. RESULTS: During 14 to 19 years of followup 87% of the patients in the radiotherapy group and 76% in the combined orchiectomy and radiotherapy group died (log rank p = 0.03). Prostate cancer mortality was 57% and 36%, respectively (log rank p = 0.02). The difference in favor of combined treatment was mainly caused by lymph node positive tumors. For node negative tumors there was no significant difference in the survival rates. CONCLUSIONS: Immediate androgen deprivation should be considered instead of deferred endocrine treatment started at clinical progression for prostate cancer with spread to regional lymph nodes. While awaiting evidence from randomized trials, one should consider full dose radiotherapy for local control of locally advanced prostate cancer even when it is lymph node positive.     

Neoadjuvant androgen withdrawal prior to external radiotherapy for locally advanced adenocarcinoma of the prostate

BACKGROUND: It is unclear whether positive interactions between radiation and androgen withdrawal for patients with locally advanced prostate cancer is synergistic or additive. The present study aimed to clarify the significance of neoadjuvant androgen ablation prior to external radiotherapy in a human prostate LNCaP tumor model and in patients with locally advanced prostate cancer. METHODS: Comparisons were made between the effect of castration prior to radiation on the growth of subcutaneous LNCaP tumors implanted into male nude mice and their serum prostate-specific antigen (PSA) levels, and the results of castration or radiation alone. Twenty-nine patients with histologically proven and locally advanced adenocarcinoma of the prostate were treated with luteinizing hormone-releasing hormone analog at least 3 months before, during, and after external radiation therapy with a total dose of 70 Gy. The toxicity and response to this therapy were evaluated. RESULTS: Treatment combining castration and radiation resulted in synergistic inhibition of LNCaP tumor growth and a significant delay in the emergence of androgen-independent recurrence as opposed to either treatment alone. The external radiotherapy was completed in 28 patients (96.6%), resulting in a reduction of serum PSA levels in all 28 patients to below 1.0 ng/mL. All patients were alive after a mean follow-up period of 34 months (range 11-53) with a 3-year PSA relapse-free survival rate of 83.7%. Among several factors examined, only the Gleason score was significantly associated with PSA relapse-free survival in univariate analysis, but not in multivariate analysis. Thirteen of 28 patients (46%) and 7 of 28 (25%) also showed at least one form of gastrointestinal or genitourinary toxicity, respectively. Of these patients, 8 with gastrointestinal toxicities, and 1 with genitourinary toxicity, experienced acute complications higher than grade 3. CONCLUSION: The experimental findings objectively suggested the use of neoadjuvant androgen withdrawal prior to radiation therapy. Although our clinical experience is preliminary, combined androgen ablation and radiation therapy may also be effective in controlling locally advanced prostate cancer, with tolerable side-effects.     

Postoperative intensity-modulated radiotherapy with simultaneous integrated boost in prostate cancer: A dose-escalation trial

ObjectivesTo determine the recommended phase II dose of postoperative accelerated intensity modulated radiotherapy (IMRT) for prostate cancer.Material and methodsStep and shoot IMRT with simultaneous integrated boost (SIB) was delivered in 25 fractions over 5 weeks to patients with high risk resected prostate adenocarcinoma (stage pT3-4 and/or positive surgical margins). Pelvic nodes received 45 Gy at 1.8 Gy/fraction; dose escalation was performed only to the prostate bed (planned dose escalation: 56.8 Gy at 2.27 Gy/fraction, 59.7 Gy at 2.39 Gy/fraction, 61.25 Gy at 2.45 Gy/fraction, 62.5 Gy at 2.5 Gy/fraction). Dose-limiting toxicity (DLT) was any grade ≥ 3 acute toxicity (RTOG score).ResultsTwenty-five patients were treated: 7 patients at the 56.75 Gy dose level, 6 patients at each subsequent dose level. Pathologic stages were: pT2c: 2; pT3a: 11; pT3b: 12; pN0: 22; pN1: 3; R0: 7; R1: 18. Median follow-up time was 19 months (range: 6–36 months). No patient experienced DLT. Grade 1–2 acute rectal and urologic toxicity was common (17 and 22 patients, respectively).ConclusionsThe recommended dose was 62.5 Gy in 2.5 Gy/fraction. Postoperative hypofractionated IMRT SIB for prostate cancer seemed to be well tolerated and could be tested in phase II studies.     

A retrospective study of the treatment of locally advanced prostate cancer by six institutions in eastern and north-eastern Japan

OBJECTIVE: To investigate patients with locally advanced prostate cancer treated at six academic institutions in eastern and north-eastern Japan from 1988 to 2000, to facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer. PATIENTS AND METHODS: The study included 391 eligible patients with locally advanced prostate cancer who were treated by radical prostatectomy (RP), radiotherapy and/or primary hormone therapy. Disease-specific survival rates for these patients were assessed in relation to their clinicopathological characteristics and the types of treatment they received. The Mann-Whitney U-test, Kruskal-Wallis, chi-square and log-rank test were used for statistical analysis, as appropriate. RESULTS: In all, 128 patient with lower prostate-specific antigen levels (P = 0.023) and/or better performance status (P = 0.001) had RP. Neoadjuvant hormone therapy before RP was the treatment in 68 (53%) of these 128 patients; 66 (52%) received immediate adjuvant hormone therapy. Of 87 patients treated with radiotherapy, 75 (86%) had external beam radiotherapy (EBRT) as the primary treatment with no brachytherapy, and 12 (14%) had brachytherapy as the primary method. Neoadjuvant hormone therapy was given to 56 of the 87 patients (64%); 48 (55%) received immediate adjuvant hormone therapy. Of the 176 patients treated with primary hormone therapy alone, combined androgen blockade and surgical or medical castration was the treatment in 76 (43%) and 85 (48%), respectively. Disease-specific survival rates at 5 years for patients treated with RP, EBRT and primary hormone therapy were 90%, 98%, and 89%, respectively. CONCLUSION: The treatments provided by the participating institutions did not differ significantly from those set out in European and American guidelines, and short-term disease-specific survival rates for each treatment did not differ significantly from those of historical controls. Further investigation may facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer.     

Evaluating the use of early hormonal therapy in patients with localised or locally advanced prostate cancer

This article evaluates the use of early hormonal therapy in patients with localised or locally advanced prostate cancer. In patients receiving radiotherapy, an overall survival benefit is proven for adjuvant goserelin ('Zoladex') in locally advanced disease. Adjuvant to radical prostatectomy, castration (goserelin or orchiectomy) has demonstrated an overall survival benefit in patients with lymph node metastases. Survival advantages have not yet been proven with nonsteroidal antiandrogens, but immediate or adjuvant bicalutamide ('Casodex') improves objective progression-free survival in patients with locally advanced disease, with certain quality-of-life advantages over castration.     

Organ-confined prostate cancer: treatment with high doses of radioterapy (intensity modulated radiotherapy)

PurposeTo report toxicity and local control in patients with localized prostate cancer, treated with high dose radiotherapy.Materials and methodsThe records of 100 consecutive patients with clinically localized prostate cancer treated between june 2003 and may 2006 were reviewed. They received 80 Gy to the target volume with a biphasic technique (3DCRT + IMRT). The median pretreatment PSA was 9. The median follow-up time was 12 months.ResultsEighteen (18%) developed acute Grade 2 rectal toxicity, and no patient experienced acute grade 3 or higher rectal symptoms. Forty-four (44%) developed acute Grade 2 urinary symptoms while 34% of the patients experienced no GU symptoms (Grade 0) during treatment. Three patients (3%) developed late rectal toxicity grade 2 and eight patients (8%) experienced late urinary toxicity grade 2; any patients experienced more severe symptoms.We recorded biochemical relapse in two patients, both had poor prognostic factors at initial diagnosis of prostate cancer.ConclusionsThe data demonstrate the feasibility and safety of high dose radiotherapy for patients with localized prostate cancer and provide a proof that this method allow safe dose escalation with low severe toxicities to the normal tissues.