Karasawa Katsuyuki, Kaizu Toshihide, Niibe Yuzuru, Igaki Hiroshi, Shinohara Mitsuru, Tanaka Yoshiaki, Matsuda Tadayoshi
Department of Radiology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Int J Radiat Oncol Biol Phys. 2003 May 1;56(1):208-12. doi: 10.1016/s0360-3016(03)00084-1.
In our institution, rotational 3D-conformal radiation therapy (also called conformation therapy) has been applied since the late 1970s to conform the target volume of high-dose radiation to the cancerous tissue while minimizing radiation to the surrounding normal tissues. This technique has been used most commonly to treat prostate cancers in combination with hormonal therapy. The results of Stage B2/C prostate cancer treated with this method were analyzed.
Between 1987 and 1997, 33 cases of prostate cancer were definitively treated with this method: 9 Stage B2 tumors and 24 Stage C tumors. Of these 33 tumors, 3 were well differentiated, 18 were moderately differentiated, and 12 were poorly differentiated. The average patient age was 75.6 years. The median pretreatment PSA value was 23.8 ng/ml. The total radiation dose ranged from 60 Gy to 70 Gy (average: 63.5 Gy) with conventional fractionation. Hormone therapy was administered permanently; the primary hormonal agent was diethylstilbestrol phosphate.
The overall survival rate after 5 years was 58.2% and that after 10 years was 29.6%. The biochemical relapse-free rate after 5 years was 87.0% and that after 10 years was still 87.0%. There were 4 cases of biochemical failure, but no cases of death from prostate cancer. Stage, differentiation, and pretreatment PSA value were not prognostic factors. One of the 2 cases with delayed complications was a case of RTOG Grade 3 gastrointestinal complication.
Rotational 3D-conformal radiation therapy combined with hormone therapy might be promising for the treatment of prostate cancer.
自20世纪70年代末起，我院开始应用旋转式三维适形放射治疗（也称为适形治疗），以使高剂量放射的靶区与癌组织相符，同时将对周围正常组织的放射降至最低。该技术最常用于联合激素治疗前列腺癌。分析了用此方法治疗B2/C期前列腺癌的结果。
1987年至1997年间，33例前列腺癌患者接受了该方法的确定性治疗：9例B2期肿瘤和24例C期肿瘤。在这33例肿瘤中，3例高分化，18例中分化，12例低分化。患者平均年龄为75.6岁。治疗前PSA值中位数为23.8 ng/ml。采用常规分割，总放射剂量为60 Gy至70 Gy（平均：63.5 Gy）。永久给予激素治疗；主要激素制剂为磷酸己烯雌酚。
5年总生存率为58.2%，10年为29.6%。5年生化无复发生存率为87.0%，10年时仍为87.0%。有4例生化失败，但无前列腺癌死亡病例。分期、分化程度和治疗前PSA值不是预后因素。2例延迟并发症患者中有1例为RTOG 3级胃肠道并发症。
旋转式三维适形放射治疗联合激素治疗可能是治疗前列腺癌的一种有前景的方法。
