Nasr E, Merhej S, Nehme Nasr D, Fares G
Service de Radiothérapie, Hôtel-Dieu de France, Beyrouth, Liban, Université Saint-Joseph, Faculté de Médecine.
J Med Liban. 2001 Nov-Dec;49(6):325-8.
To report our experience with 3D conformal radiotherapy for prostate cancer.
We reviewed our first 50 patients diagnosed with prostate cancer. Median follow-up was 27 months (16-40 m). Median age 68 (52-74). T stage was: T1c = 12 ; T2a = 14; T2b = 10; T2c = 2; T3a = 10; T3b = 1 and T3c = 1. Gleason score (GS) 4-6 50% and GS 7-8 50%. Pretreatment PSA value of < 10 ng/ml 36%, 10-20 ng/ml 32% and > 20 ng/ml 32%. Forty patients received androgen ablation therapy 2 to 6 months before radiation. 3D conformal radiotherapy was used to allow a smaller amount of rectum and bladder to be in the high dose volume. An 18 Mv linear accelerator was used. The first 21 patients received 66 Gy, 28 patients received 70 Gy and one 74 Gy.
The mean prostate volume was 45 cc for patients who received androgen ablation and 54 for the others (p = 0.02). The percentage of volume receiving more than 50 Gy (V50) was calculated for the rectum and bladder. The median V50 was 30% (10-55) for the rectum and 36% (5-70) for the bladder. Based on the RTOG grading (gr) for acute toxicity, there was no gr 3 gastrointestinal (GI) toxicity and only 1 gr 3 genitourinary (GU) toxicity. There were 9 gr 1 and 5 gr 2 GI toxicity, 10 gr 1 and 5 gr 2 GU toxicity. With our actual follow-up we have 2 late morbidities: gr 2 GU and one erectile failure.
3D conformal radiotherapy for prostate cancer has a good toxicity profile. Longer follow-up is needed to assess late toxicity and clinical outcome in this series.
报告我们在前列腺癌三维适形放疗方面的经验。
我们回顾了最初诊断为前列腺癌的50例患者。中位随访时间为27个月（16 - 40个月）。中位年龄68岁（52 - 74岁）。T分期为：T1c = 12例；T2a = 14例；T2b = 10例；T2c = 2例；T3a = 10例；T3b = 1例；T3c = 1例。 Gleason评分（GS）4 - 6分占50%，GS 7 - 8分占50%。放疗前前列腺特异抗原（PSA）值<10 ng/ml的占36%，10 - 20 ng/ml的占32%，>20 ng/ml的占32%。40例患者在放疗前2至6个月接受了雄激素剥夺治疗。采用三维适形放疗以使较少的直肠和膀胱处于高剂量体积内。使用18兆伏直线加速器。前21例患者接受66 Gy照射，28例患者接受70 Gy照射，1例接受74 Gy照射。
接受雄激素剥夺治疗的患者前列腺平均体积为45立方厘米，未接受该治疗的患者为54立方厘米（p = 0.02）。计算直肠和膀胱接受超过50 Gy照射的体积百分比（V50）。直肠V50的中位数为30%（10 - 55），膀胱为36%（5 - 70）。根据美国放射肿瘤学会（RTOG）急性毒性分级，无3级胃肠道（GI）毒性，仅有1例3级泌尿生殖系统（GU）毒性。有9例1级和5例2级GI毒性，10例1级和5例2级GU毒性。在我们的实际随访中，有2例晚期并发症：2级GU毒性和1例勃起功能障碍。
前列腺癌三维适形放疗的毒性反应良好。需要更长时间的随访来评估该系列中的晚期毒性和临床结局。
