Fan Kang-Hsing, Chen Yen-Chao, Chuang Cheng-Keng, Hsieh Min-Li, Hong Ji-Hong
Department of Radiation Oncology, Chang Gung Memorial Hospital, Taipei.
Chang Gung Med J. 2006 May-Jun;29(3):313-24.
To review the initial treatment results of intensity-modulated radiotherapy (IMRT) for prostate cancer.
Ninety-two patients treated with IMRT before July 2003 were included in this study. The median follow-up was 32 months. The indications for IMRT included primary, adjuvant, and salvage treatment. Combined treatment with androgen suppression therapy was variable. The primary study endpoints were chronic adverse events which were subjectively reported. Only patients with an adenocarcinoma and who had been treated by primary radiotherapy were included in the analysis of disease relapse.
At the time of analysis, 89 patients were still alive, and only 2 patients had died of prostate cancer. In the survival analysis, the 30-month failure-free survival rates were 100%, 89.2%, and 67.3% for the low-, intermediate-, and high-risk groups of patients, respectively. Pretreatment PSA level, Gleason score, risk classification, and adjuvant hormone therapy were significantly associated with relapse according to the univariate analysis, while only risk classification remained significant in the multivariate analysis. During follow-up, 5 (6%) patients developed grade 2 gastrointestinal (GI) adverse events (AE). Sixteen (18%) and 7 (8%) patients developed grade 2 and 3 urinary AE, respectively. Development of severe urinary adverse events was closely related to previous surgical treatment. No factor was identified as being correlated with the GI adverse events. The preservation rate of sexual function was 25.7%.
Seventy-two Grays of irradiation, administered by IMRT, is a safe method as the primary treatment for prostate cancer. However, severe urinary toxicity was related to previous surgical treatment. There is a need for longer follow-up periods to verity the benetit of this dosage level.
回顾调强放疗（IMRT）治疗前列腺癌的初始治疗结果。
本研究纳入了2003年7月前接受IMRT治疗的92例患者。中位随访时间为32个月。IMRT的适应证包括初次治疗、辅助治疗和挽救性治疗。雄激素抑制治疗的联合方式各不相同。主要研究终点是主观报告的慢性不良事件。仅腺癌患者且接受初次放疗的患者纳入疾病复发分析。
分析时，89例患者仍存活，仅2例死于前列腺癌。在生存分析中，低、中、高危组患者的30个月无失败生存率分别为100%、89.2%和67.3%。单因素分析显示，治疗前前列腺特异性抗原（PSA）水平、 Gleason评分、风险分类和辅助激素治疗与复发显著相关，而多因素分析中只有风险分类仍具有显著性。随访期间，5例（6%）患者发生2级胃肠道（GI）不良事件（AE）。分别有16例（18%）和7例（8%）患者发生2级和3级泌尿系统AE。严重泌尿系统不良事件的发生与既往手术治疗密切相关。未发现与GI不良事件相关的因素。性功能保留率为25.7%。
IMRT给予72格雷的照射作为前列腺癌的主要治疗方法是一种安全的方法。然而，严重的泌尿系统毒性与既往手术治疗有关。需要更长的随访期来验证这种剂量水平的益处。
