Wiegel T, Tepel J, Schmidt R, Klosterhalfen H, Arps H, Berger P, Franke H D
Department of Radiotherapy, University Hospital Hamburg-Eppendorf, Germany.
Strahlenther Onkol. 1996 Nov;172(11):596-603.
To evaluate the value of radiotherapy and immediate hormonal therapy in the treatment of stage C prostate cancer.
From 1977 to 1986, 169 patients with clinically stage C prostate cancer underwent irradiation with curative intent following early orchiectomy. Sixty-four patients had a transurethral resection, 22 patients a prostatectomy and 83 patients had only a biopsy. In 38 patients a grade Ia/b tumor was found, in 78 patients a grade IIa/b tumor and in 43 patients a grade IIIa/b tumor using the German grade of malignancy. Treatment fields included the prostate, the seminal vesicles and the locoregional lymphatics. Until 1979 the dose was 60 Gy for the tumor encompassing isodose and from then on 65 Gy with a single dose of 2 Gy.
With a median follow-up of 98 months, the overall survival rate for 8 and 10 years was 51% and 37% and the cause specific survival rate was 84% and 77%, respectively. Thirty-two patients (19%) developed distant metastases. Patients with local tumor control (n = 148) had a significantly better overall survival rate of 45% for 10 years compared to patients with clinical local progression of disease (n = 21) of 22% (p < 0.05). Multivariate analysis showed the grade of malignancy and local control as independent factors for overall survival and cause-specific survival (p < 0.05). Twenty-three patients (14%) had at least one late side effect for the rectum or the bladder, in almost all cases grade I or II. Five patients (3%) showed severe late side effects RTOG grade III (n = 2) or IV (n = 3). One patient had a colostomy, in 2 patients a severe haemorrhagic cystitis was seen.
Radiotherapy with photons and early orchiectomy for patients with stage C prostate cancer achieves high local control rates and a 30% to 40% 10-year survival rate with a low incidence of late side effects. The value of the radiotherapy of the locoregional lymphatics remains controversial.
评估放射治疗和即刻激素治疗在C期前列腺癌治疗中的价值。
1977年至1986年，169例临床C期前列腺癌患者在早期睾丸切除术后接受了根治性放疗。64例患者接受了经尿道切除术，22例患者接受了前列腺切除术，83例患者仅接受了活检。采用德国恶性肿瘤分级标准，38例患者为Ia/b级肿瘤，78例患者为IIa/b级肿瘤，43例患者为IIIa/b级肿瘤。治疗野包括前列腺、精囊和局部区域淋巴结。1979年前，肿瘤等剂量包绕区的剂量为60 Gy，从那时起为65 Gy，单次剂量为2 Gy。
中位随访98个月，8年和10年的总生存率分别为51%和37%，病因特异性生存率分别为84%和77%。32例患者（19%）发生远处转移。局部肿瘤得到控制的患者（n = 148）10年总生存率为45%，明显高于疾病临床局部进展的患者（n = 21），后者为22%（p < 0.05）。多因素分析显示，恶性肿瘤分级和局部控制是总生存和病因特异性生存的独立因素（p < 0.05）。23例患者（14%）至少出现一种直肠或膀胱晚期副作用，几乎所有病例为I级或II级。5例患者（3%）出现严重晚期副作用，放射肿瘤学协作组（RTOG）分级为III级（n = 2）或IV级（n = 3）。1例患者行结肠造口术，2例患者出现严重出血性膀胱炎。
C期前列腺癌患者接受光子放疗和早期睾丸切除术可实现较高的局部控制率和30%至40%的10年生存率，且晚期副作用发生率较低。局部区域淋巴结放疗的价值仍存在争议。
