三维适形放疗联合激素阻断治疗方案在晚期前列腺癌的临床应用

目的：探讨三维适形放疗联合激素阻断治疗方案在晚期前列腺癌的临床疗效。方法：将我院2003年1月-2008年12月收治60例晚期前列腺癌随机分为联合治疗组（放疗+激素阻断）、单一组（激素阻断）两组,每组30例。联合组放疗采用三维适形放疗（总剂量70-72 Gy,4-7周完成）;激素阻断治疗、单一激素阻断治疗组皆采用康士德+诺雷德方案（康士德50mg/日,顿服,诺雷德3.75 mg,皮下注射,1次/月,平均治疗周期12个月）。分别记录两组治疗后近期疗效（IPSS表评估下尿路症状缓解情况、VAS评分表评估疼痛情况、MRI复查评估肿瘤体积变化、血清PSA变化）、不良反应（胃肠道反应、肝肾功受损情况）、随访后评估患者生存率。结果：联合治疗组相比单一治疗组,IPSS评分下降更明显,疼痛减轻更显著,前列腺肿瘤体积下降更明显,血清PSA变化下降更明显,差异比较均有统计学意义（P<0.05）;不良反应相对较大,但差异比较无统计学意义（P>0.05）;随访后患者生存率更高,差异比较有统计学意义（P<0.05）。结论：三维适形放疗联合激素阻断治疗方案最大限度的解除了患者病痛和提高了患者的生存率,可以为晚期前列腺癌尤其是非雄激素依赖型前列腺癌的临床诊治提供新的治疗方法。     

三维适形放疗加内分泌联合治疗晚期前列腺癌

目的评价三维适形放疗加内分泌联合治疗晚期前列腺癌的效果。方法对晚期前列腺癌患者25例行3DCRT 内分泌联合治疗(联合组),以同期进行的单纯内分泌治疗的晚期前列腺癌患者40例为对照组。随访时间3~48个月,中位随访期27个月。结果联合组3年生存率为88.0%,明显高于对照组(68.0%)。在30个月后,联合组的PSA低于对照组,差异有统计学意义(P<0.05)。结论3DCRT 内分泌联合治疗晚期前列腺癌疗效满意,优于单纯内分泌治疗。     

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。     

I125放射性粒子植入联合低剂量调强适形放疗及内分泌治疗在中晚期前列腺癌中的临床疗效评价

目的 探讨I125放射性粒子植入(BT)联合低剂量调强适形放疗(IMRT)及间歇内分泌治疗(IHT)在中晚期前列腺癌中的临床疗效.方法 回顾性分析选择2009年9月～2014年3月采用BT联合IMRT及IHT治疗中晚期前列腺癌患者16例作为联合治疗组;选择同期单纯采用间歇内分泌治疗患者25例作为对照组.比较两种治疗方法对于治疗中晚期前列腺癌临床疗效的差异.结果 16例随访21 ～ 62个月,中位随访时间46个月.与对照组相比,联合组PSA、IPSS评分、尿流率及前列腺体积明显下降(P＜0.05),联合治疗5年累计生存率为48.3％,高于对照组的43.2％,差异有统计学意义(P＜0.05).结论 BT植入联合低剂量IMRT及IHT治疗中晚期前列腺癌,可有效提高患者生存率,是中晚期前列腺癌治疗可选择的有效手段之一.     

中晚期前列腺癌去势联合伽玛刀治疗

目的总结伽玛刀结合去势手术治疗中晚期前列腺癌疗效。方法15例前列腺癌患者,比较双侧睾丸切除 伽玛刀治疗前后PSA、排尿症状评分、残余尿最、尿流率、治疗并发症发生率,0．5-2年后前列腺体积变化。结果双侧睾丸切除后1周,PSA迅速下降至原基础值一半,伽玛刀治疗一疗程后,PSA下降至4．0μg／L以下,最大尿流率增加,国际前列腺症状评分下降,残余尿量减少,放疗后6个月复查肿瘤明显缩小或消失, 0．5-1年、1-2年后复查前列腺体积缩小。治疗无明显并发症。结论中晚期前列腺癌伽玛刀配合去势治疗,不仅能使肿瘤消退,缓解癌细胞生长,减慢病情进展,消除转移灶,而且能显著改善排尿症状,使前列腺体积缩小,无明显放射并发症。     

肾上腺分泌雄激素与前列腺癌

临床医生在对晚期前列腺癌患者治疗过程中,往往采用雄激素全部阻断。但是近年在全雄激素阻断治疗过程中出现的问题越来越多。本文结合近年来研究,得出以下四点结论:前列腺细胞在体内增殖是多因素结果,不是单纯雄激素作用结果。男性随着年龄增加,雄激素水平降低,前列腺癌发病率增高。在正常男性服用适量雄激素可能起到预防前列腺癌发生的作用。肾上腺来源雄激素和前列腺癌的复发需要进一步研究证实。     

雄激素非依赖性前列腺癌发生的相关分子机制研究进展

前列腺癌由雄激素依赖性进展为雄激素非依赖性成为前列腺癌治疗的瓶颈,其发生的分子机制是目前国内外研究的热点.本文就雄激素非依赖性前列腺癌发生的相关分子机制作一综述,并对未来雄激素非依赖性前列腺癌的治疗提出了方向.     

肾上腺源雄激素的代谢与前列腺癌

前列腺癌近来在我国发病率逐年上升;传统认为大部分前列腺癌起初为雄激素依赖性,但去势后前列腺癌对肾上腺源雄激素的依赖性如何,则认识不清;肾上腺源雄激素,特别是去势后,是否对前列腺癌的生长有刺激?何时对前列腺癌有作用?这种作用与前列腺癌内分泌治疗时出现的进展是否相关?对该进展型的前列腺癌又是否具有生长刺激?这些问题存在诸多争议与模糊之处。本文以肾上腺源雄激素的代谢为视角,归纳并分析近年前列腺癌雄激素依赖的基础与临床研究进展,详细阐述了肾上腺源雄激素是去势后前列腺癌继续赖于生长、临床疾病进展的重要刺激因素。     

四羟基壬烯的表达及其在前列腺癌雄激素拮抗中的作用

探讨四羟基壬烯(4-hydroxynonenal,4-HNE) 的表达及其在前列腺癌雄激素拮抗中的作用。方法 采用免疫组织化学方法检测40例前列腺癌组织及42例前列腺增生组织中4-HNE 的表达情况,分析4-HNE的表达与肿瘤进展性的关系。结果 4-HNE在42例前列腺增生组织中阳性表达率较低,仅为4.8%。40例前列腺癌组织中4-HNE高表达,去势抵抗性前列腺癌阳性率评分明显高于非去势抵抗性前列腺癌,差异有统计学意义（P＜0.01）。结论 4-HNE的高表达,可能在前列腺癌的进展和雄激素拮抗中起重要作用。     

Three-dimensional conformal radiation therapy for prostate cancer in Hamamatsu Medical Center

We retrospectively evaluated acute and late radiation morbidity and short-term PSA relapse-free survival of 53 patients with localized prostate cancer who received three dimensional radiation therapy (3D-CRT) that targeted prostate and seminal vesicles in Hamamatsu Medical Center from 1999.10 to 2005.4. The total dose was increased from 70 to 74 Gy in increments of 2.0 Gy. We divided these patients into two groups who received 70-72 Gy or 74 Gy. Then we analyzed whether there were differences between those two groups in acute radiation morbidity. We also analyzed late radiation morbidity in the 70(-)-72 Gy group. Acute radiation morbidity and late morbidity were described according to the RTOG acute radiation morbidity scoring criteria 1995 and RTOG/EORTC late radiation morbidity scoring scheme 1995, respectively. No acute grade 3 or 4 toxicity and no late grade 4 toxicity was observed. Late grade 3 rectal bleeding was observed in only one patient who received 70 Gy. Acute toxicity was well tolerated and did not correlate with total dose.     

Health-related quality-of-life after external beam radiation therapy for localized prostate cancer: intensity-modulated radiation therapy versus conformal radiation therapy

We compared health-related quality-of-life (HRQL) after intensity-modulated radiotherapy (IMRT) with statuses obtained after old and new protocols of three-dimensional conformal radiation therapy (3DCRT) for localized prostate cancer. We measured the general and disease specific HRQL using the MOS 36-Item Health Survey (SF-36), and the University of California, Los Angeles Prostate Cancer Index (UCLA PCI), respectively. IMRT resulted in similar profiles of general and disease-specific HRQL to two other methods within the first year after treatment. Moreover, IMRT gave rise to comparable urinary, intestinal and sexual side effects despite the high dose of radiation applied.     

High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer

OBJECTIVES: To evaluate the outcome of high dose rate (HDR) brachytherapy with iridium 192 (Ir(192)) and 3D conformal external beam radiotherapy in patients with localized prostate cancer. METHODS: A total of 442 patients with localized prostate cancer underwent combined radiotherapy with interstitial brachytherapy with Ir(192) and 3D conformal external beam radiotherapy between December 1992 and March 2001. Patients underwent laparoscopic pelvic lymph node dissection to exclude patients with lymphatic involvement. Iridium 192 was delivered twice with a one-week interval in afterloading technique. 247 patients (56%) had clinical T3 disease and 128 patients (29%) had an initial PSA of more than 20 ng/ml. Progression was defined as biochemical failure according to ASTRO criteria. Patients were divided according to pretreatment variables that independently affected prostate-specific antigen (PSA) relapse-free survival in three risk groups. Low risk was defined as cT1c-cT2 and G1-G2 and PSA<10 ng/ml (n=94). Intermediate risk included patients with cT1c-cT2 and G1-G2 and PSA between 10 and 20 ng/ml (n=53). High risk group patients were cT3 or G3 or PSA>20 ng/ml (n=295). RESULTS: Median follow-up was 5 years. Late grade 3-4 complications according to RTOG/EORTC criteria occurred in 50 patients (11%).The initial PSA value decreased from median 11.8 ng/ml to 0.98 ng/ml 12 months after treatment, to 0.3 ng/ml after 60 months and to 0.1 ng/ml 10 years after therapy. 53% of the patients (n=235) reached a PSA nadir of 0.5 ng/ml. 66 patients (15%) had a local recurrence, 54 (12%) developed systemic disease and 12 (3%) had both local and systemic failure. The progression free survival rate was 65% at 5-year follow-up. Five-year progression free survival was 81% in the low risk group, 65% in the intermediate risk group and 59% in the high risk group. Five-year overall survival was 87% and 5-year disease specific survival 94%. Initial PSA value, risk group and age were significantly related to progression free survival. CONCLUSIONS: Combined HDR brachytherapy with Iridium 192 is an alternative treatment option for patients with localized prostate cancer. Initial PSA value, risk group, and age are important prognostic factors for progression free survival.     

Three-dimensional conformal radiotherapy for localized prostate cancer in kidney transplant recipients

BACKGROUND: This is the first report of graft function and prostate cancer control in renal transplant recipients subjected to modern conformal radiotherapy. METHODS: Eight kidney transplant recipients were treated with three-dimensional conformal radiotherapy. All patients but one were subjected to transitory hormonal deprivation. A three-dimensional radiotherapy-planning system (Pinnacle, Philips Medical System, Bothell, WA) was used to delineate anatomic contours on pretreatment computed tomography and for dose computation. The clinical target volume encompassed the prostate and was expanded with a 10-mm wide margin in all directions to obtain the planning target volume. The irradiation technique consisted of a nine-field arrangement delivering 70 Gy in 2-Gy fractions, with 18-MV photon beams. Biochemical recurrence was defined as two consecutive increases in prostate-specific antigen (>1.5 ng/mL). Graft function was monitored by creatinine clearance. Excretory profiles were assessed by furosemide-stimulated diethylenetriaminepentaacetic acid renography. All patients were subjected to hip magnetic resonance imaging to assess for avascular hip necrosis. RESULTS: After a mean follow-up of 28 months, two patients showed isolated biochemical recurrence and six patients remained free of recurrence. In seven patients with functional allografts, the creatinine clearance was unimpaired by treatment. However, significant obstruction of the terminal ureter was revealed in two patients by furosemide-stimulated diethylenetriaminepentaacetic acid renograms. The doses delivered to the uretero-neocystostomy were calculated to range from less than 20 Gy to more than 45 Gy depending on bladder repletion. CONCLUSIONS: Adequate cancer control was achieved at the expense of infraclinical ureteral obstruction. The doses delivered to the uretero-neocystostomy may be reduced by having a full bladder at the time of irradiation. No avascular hip necrosis was observed.     

Primary radiation therapy for localized prostate cancer

Prostate cancer in men is similar to breast cancer in women; both cancers rank first, respectively, in incidence and are normally responsive to radiation therapy. In addition, advances in mammography help detect earlier breast cancers, and the development and refinement of prostatic specific antigen (PSA) has resulted in early detection of low-stage localized prostate cancers. This has generated debate over the proper management of localized prostate cancer. While there have not been any controlled, prospective, randomized trials of sufficient power to compare the various local therapies, based on the current available data, the three commonly used local modalities, surgery, and external beam radiation therapy and brachytherapy (radioactive seed implant), have similar efficacy controlling the disease up to 10 years in many patients. Technological advances in treatment delivery and planning have improved the treatment of prostate cancer with external-beam radiotherapy using three-dimensional conformal radiotherapy (3DCRT), ultrasound-guided transperineal implant, or intensity-modulated radiotherapy (IMRT), as well as proton or neutron beam based therapies.     

辅助内分泌配合放射性粒子组织间植入治疗局限性前列腺癌

目的探讨辅助内分泌配合放射性粒子组织间植入治疗局限性前列腺癌的安全性和有效性。方法22例T1-T24前列腺癌患者在采用直肠超声引导经会阴穿刺放射性^125I粒子组织间植入治疗前后，给予辅助内分泌治疗4—7（平均5．7）个月。术前2—4（平均3．2）个月，术后1—4（平均2．1）个月。结果22例手术均顺利完成，手术时间60-120（平均90）min，植入^125I粒子数40-75（平均56）枚，术后随访12—48个月，血PSA≤1ng／mL15例，1ng／mL≤PSA≤2ng／mL2例，PSA≥2ng／mL5例。结论辅助内分泌配合放射性粒子组织间植入治疗局限性前列腺癌安全有效。     

External beam radiation therapy for clinically localized prostate cancer: when and how we optimize with concurrent hormonal deprivation

Androgen deprivation plays a major role in the treatment of prostate cancer.Preclinical studies have shown that androgen deprivation provides both an independent cytotoxic effect and radiosensitization on prostate tumors. For men with non-metastatic prostate cancer, the addition of androgen deprivation to radiotherapy has been shown to improve survival for intermediate and high risk disease compared to radiation alone.This review discusses the clinical trial data regarding combination of androgen deprivation and radiation and provides recommendations for its use in men undergoing radiotherapy for localized prostate cancer.