Perez C A, Cosmatos D, Garcia D M, Eisbruch A, Poulter C A
Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63108.
Cancer. 1993 Feb 1;71(3 Suppl):1110-22. doi: 10.1002/1097-0142(19930201)71:3+<1110::aid-cncr2820711433>3.0.co;2-5.
Radiation therapy plays a major role in the management of patients with either locally recurrent or metastatic carcinoma of the prostate.
In 23 patients with isolated postprostatectomy local recurrences treated with doses of 60-65 Gy, 17 (74%) had tumor control, and 45% survived relapse-free for 5 years after treatment of the recurrence. Pelvic irradiation has been used to treat patients with elevated prostate-specific antigen (PSA) levels after radical prostatectomy. This was tried, and 17 of 24 patients (70%) showed a significant decrease in PSA levels after irradiation, in five without subsequent elevation. Two of the seven patients with elevated PSA levels later had distant metastases. Local irradiation has been reported to yield excellent relief of symptoms in 100% of patients with hematuria, 80% with urinary outflow obstruction, and 50-70% with ureteral obstruction or pelvic pain secondary to locally advanced prostatic carcinoma. Reirradiation, particularly with brachytherapy (in preliminary studies combined with hyperthermia) has been used in the management of postirradiation prostatic recurrences with satisfactory tumor regression in approximately 75% of patients. The Radiation Therapy Oncology Group (RTOG) reported on the palliative effects of external irradiation on patients with bony metastasis. Approximately 54% of such patients had complete relief, and 29% had partial relief of bone pain. However, the retreatment rate of the bony metastasis was lower in the patients receiving higher doses. In a RTOG protocol in which all patients received local irradiation for osseous metastases, 77 were randomized to receive elective hemibody irradiation and 69, local treatment only. The frequency of additional treatment at 1 year was lower in the hemibody irradiation group (54% versus 78%). Occasionally, brain, mediastinal, or liver metastasis can be treated with irradiation. Radioactive phosphorus-32 or strontium-89 has been administered for disseminated bony metastasis with improvement of bone pain in approximately 70-80% of treated patients.
The role of irradiation in the treatment of spinal cord compression is discussed. Significant improvement of neurologic function has been reported in 36-60% of the patients, depending on severity of deficit and promptness in instituting emergency treatment.
放射治疗在局部复发或转移性前列腺癌患者的治疗中起着重要作用。
在23例接受60 - 65 Gy剂量治疗的前列腺切除术后孤立局部复发患者中，17例（74%）实现了肿瘤控制，45%在复发治疗后5年无复发生存。盆腔照射已用于治疗前列腺癌根治术后前列腺特异性抗原（PSA）水平升高的患者。对此进行了尝试，24例患者中有17例（70%）在照射后PSA水平显著下降，其中5例随后未再升高。7例PSA水平升高的患者中有2例后来发生了远处转移。据报道，局部照射能使100%的血尿患者、80%的尿路梗阻患者以及50 - 70%因局部晚期前列腺癌导致输尿管梗阻或盆腔疼痛的患者症状得到显著缓解。再照射，尤其是近距离放射治疗（在初步研究中与热疗联合使用）已用于治疗放射后前列腺复发，约75%的患者肿瘤实现了满意的消退。放射治疗肿瘤学组（RTOG）报告了外照射对骨转移患者的姑息作用。约54%的此类患者骨痛完全缓解，29%部分缓解。然而，接受较高剂量治疗的患者骨转移的再治疗率较低。在一项RTOG方案中，所有患者均接受骨转移的局部照射，77例被随机分配接受选择性半身照射，69例仅接受局部治疗。半身照射组1年时额外治疗的频率较低（54%对78%）。偶尔，脑、纵隔或肝转移也可通过照射治疗。已对播散性骨转移患者给予放射性磷 - 32或锶 - 89，约70 - 80%接受治疗的患者骨痛得到改善。
讨论了照射在治疗脊髓压迫中的作用。据报告，根据神经功能缺损的严重程度和启动紧急治疗的及时性，36 - 60%的患者神经功能有显著改善。
