Jain Neeraj, Jain Anshi, Sharma Ramita, Sachdeva Kanchan, Kaur Amandeep, Sudan Meena
Department of Radiation Oncology, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India.
Department of Medicine, G D Somaya Medical College, Mumbai, Maharashtra, India.
Ann Afr Med. 2024 Oct 1;23(4):680-683. doi: 10.4103/aam.aam_216_23. Epub 2024 Sep 14.
Radical prostatectomy is appropriate for any patient whose cancer appears clinically localised to prostate. However because of potential perioperative morbidity, radical prostatectomy is generally reserved for patients whose life expectancy is more than ten years. Moderate hypofractionation for localized prostate cancer is safe and effective. There is a growing body of evidence in support of extreme hypofractionation for localized prostate cancer. Hypofractionation for prostate cancer was originally carried out in the pursuit of efficiency and convenience, but has now attracted greatly renewed interest based upon a hypothesis that prostate cancers have a higher sensitivity to fraction size, reflected in a low α/β ratio, then do late responding organs at risk such as the rectum or bladder.
From January 2017 to December 2020 we treated 112 patients of localised Prostate Cancer with Image Guided Radiotherapy (IGRT). They were in range of 75-85 years. They were of stage T1-T3, N0 or N1. There were significant comborbidities. ECOG performance status was 0-1. They were given 3 months of Androgen Deprivation Therapy (ADT) before starting IGRT. Patients were immobilised with casts and subject to CT simulation. CBCT was taken daily. Dose was 70 Gy @ 250 cGy per fraction at a frequency of 5 fractions per week. Complete blood counts were done weekly for assessment of haematological toxicity. Androgen Deprivation Therapy was continued post IGRT.
All the patients were able to complete the treatment. Evaluation was done at one month, three month and six months post treatment. 104 out of 112 patients achieved complete response. Other 8 had near complete response. There were no acute grade 3-4 toxicities. Grade 1-2 toxicities like skin desquamation, diarrhoea, burning micturition were managed conservatively. Late toxicity was rectal bleeding seen after one year of completion of treatment and was managed with steroid enemas. 23 patients required argon plasma laser therapy.
Image guided radiotherapy is well tolerated, easy to implement and an effective alternative to radical prostatectomy in elderly patients with comorbidities and low life expectancy.
根治性前列腺切除术适用于任何临床上癌症局限于前列腺的患者。然而，由于围手术期存在潜在的发病率，根治性前列腺切除术通常仅适用于预期寿命超过十年的患者。局部前列腺癌的适度低分割放疗是安全有效的。越来越多的证据支持局部前列腺癌的超分割放疗。前列腺癌的低分割放疗最初是为了追求效率和便利性，但现在基于一种假设重新引起了人们极大的兴趣，即前列腺癌对分割剂量的敏感性更高，表现为低α/β比值，而对直肠或膀胱等晚期反应性危及器官的敏感性较低。
2017年1月至2020年12月，我们对112例局限性前列腺癌患者进行了图像引导放射治疗（IGRT）。他们的年龄在75至85岁之间。分期为T1-T3、N0或N1。存在明显的合并症。东部肿瘤协作组（ECOG）体能状态为0-1。在开始IGRT前，他们接受了3个月的雄激素剥夺治疗（ADT）。患者用石膏固定并进行CT模拟。每天进行CBCT扫描。剂量为70Gy，每次分割250cGy，每周照射5次。每周进行全血细胞计数以评估血液学毒性。IGRT后继续进行雄激素剥夺治疗。
所有患者均能完成治疗。在治疗后1个月、3个月和6个月进行评估。112例患者中有104例达到完全缓解。另外8例接近完全缓解。没有3-4级急性毒性反应。1-2级毒性反应如皮肤脱屑、腹泻、尿痛等通过保守治疗处理。晚期毒性反应为治疗完成1年后出现的直肠出血，通过类固醇灌肠治疗。23例患者需要氩等离子体激光治疗。
图像引导放射治疗耐受性良好，易于实施，是合并症多、预期寿命短的老年患者根治性前列腺切除术的有效替代方法。
