Sumi M, Ikeda H, Tokuuye K, Kagami Y, Murayama S, Tobisu K, Kakizoe T
Division of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
Int J Radiat Oncol Biol Phys. 2000 Sep 1;48(2):519-28. doi: 10.1016/s0360-3016(00)00614-3.
To analyze the results in patients with locally advanced prostatic carcinoma treated by hormonal therapy followed by external radiotherapy using three-dimensional conformal radiation therapy (3D-CRT) boost.
From 1987 to 1995, 46 patients with histologically proven locally advanced adenocarcinoma of the prostate were treated with 3D-CRT at the National Cancer Center Hospital, Tokyo. The neoadjuvant androgen suppression started immediately after the diagnosis followed by radical radiation therapy, according to the prospective protocol. They were treated with photons of 6-14 MV for wide fields and the boost, of which a multiple-leaf collimator of 2-cm width was available. The boosted dose was delivered with the rotational 3D-CRT, after the delivery of whole pelvis 4-field box from a dose of 40-46 Gy up to 66 Gy. The planning target volume encompassed 1 cm outside throughout the clinical target volume, and the prostate and the seminal vesicles were included in the boost field.
The 3D-CRT boost treatment completed as planned in all 46 patients. The median follow-up for all the patients was 60 months (range, 5-120 months). Nineteen of 46 patients died. Of these, 11 patients died of the intercurrent diseases. For all 46 patients, the 5- and 8-year overall survival rates were 61.3% and 42.4%, and the 5- and 8-year cause-specific survival rates were 82.4% and 64.4%, respectively. The prostate-specific antigen (PSA) relapse-free rates for 5- and 8-year were 64.6% and 52.5%, and the clinical local control rates for 5 and 8 years were 75.3% and 69.9%, respectively. The preradiation therapy PSA and the Gleason score were the factors that significantly associated with PSA relapse-free survival. Sixteen of 46 patients (35%) showed at least one form of late toxicities. Of these, 3 patients experienced late complications of Grade 3 (urinary, 2, proctitis, 1).
The treatment results were fairly good and were consistent with those in Western countries, indicating that this study shows the preliminary status of 3D-CRT for the locally advanced prostate cancer in Japan. Preradiation therapy PSA seems to be a significant predictor of PSA relapse-free survival (p = 0.004) after neoadjuvant androgen suppression.
分析局部晚期前列腺癌患者接受激素治疗后再行三维适形放射治疗（3D-CRT）加量外照射放疗的结果。
1987年至1995年，东京国立癌症中心医院对46例经组织学证实为局部晚期前列腺腺癌的患者进行了3D-CRT治疗。根据前瞻性方案，新辅助雄激素抑制在诊断后立即开始，随后进行根治性放射治疗。对大野和加量照射采用6-14MV光子，有一个2cm宽的多叶准直器可供使用。在全盆腔4野盒式照射从40-46Gy剂量增至66Gy后，采用旋转3D-CRT给予加量剂量。计划靶体积在整个临床靶体积外扩1cm，加量野包括前列腺和精囊。
46例患者均按计划完成了3D-CRT加量治疗。所有患者的中位随访时间为60个月（范围5-120个月）。46例患者中有19例死亡。其中，11例患者死于并发疾病。对于所有46例患者，5年和8年总生存率分别为61.3%和42.4%，5年和8年病因特异性生存率分别为82.4%和64.4%。5年和8年前列腺特异性抗原（PSA）无复发生存率分别为64.6%和52.5%，5年和8年临床局部控制率分别为75.3%和69.9%。放疗前PSA和Gleason评分是与PSA无复发生存显著相关的因素。46例患者中有16例（35%）出现至少一种形式的晚期毒性反应。其中，3例患者出现3级晚期并发症（泌尿系统2例，直肠炎1例）。
治疗结果相当不错，与西方国家的结果一致，表明本研究展示了日本3D-CRT治疗局部晚期前列腺癌的初步情况。放疗前PSA似乎是新辅助雄激素抑制后PSA无复发生存的重要预测指标（p = 0.004）。
