Feldmann H J, Breul J, Zimmermann F, Wachter S, Wiegel T
Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Technischen Universität München.
Strahlenther Onkol. 1998 Nov;174(11):566-70. doi: 10.1007/BF03038293.
The development of objective criteria for selecting patients for seminal vesicle irradiation on radical radiotherapy for prostate cancer will be important for successful planning of 3D conformal radiotherapy.
Based on morphometric studies from radical prostatectomy specimens, new imaging modalities with potential in the investigation of patients with gross seminal vesicle involvement and clinical factors with potential in the identification of patients with subclinical disease the development of objective guidelines is possible.
Clinical tumor stage as determined by digital rectal examination, diagnostic tumor biopsy (Gleason Score), and pretherapy serum prostate-specific antigen value were significant factors for the probability of involvement of seminal vesicles. Studies show that seminal vesicle involvement is unlikely if the PSA is < 4 ng/ml or 4 to 10 ng/ml and Gleason Score < 7 and stage < or = T2b. In contrast, involvement of seminal vesicles is highly likely with levels above 20 ng/ml. In patients with PSA levels between 10 and 20 ng/ml and Gleason Score < 7 ultrasonographic findings with regard to tumor volume and localization will be useful to determine the extent of the target volume. For treatment planning a significant reduction in the volumes of irradiation to the rectum and bladder is evident when seminal vesicles were excluded.
Prospective use of the objective criteria will be useful in the selection of patients for seminal vesicle involvement and should be an integral part in 3D conformal radiotherapy of prostate cancer.
制定客观标准以选择前列腺癌根治性放疗时接受精囊照射的患者，对于成功规划三维适形放疗至关重要。
基于前列腺癌根治术标本的形态学研究，有可能开发出在评估精囊明显受累患者时具有潜力的新成像模式，以及在识别亚临床疾病患者时具有潜力的临床因素，从而制定客观指南。
通过直肠指检确定的临床肿瘤分期、诊断性肿瘤活检（ Gleason评分）以及治疗前血清前列腺特异性抗原值是精囊受累可能性的重要因素。研究表明，如果PSA<4 ng/ml或4至10 ng/ml且Gleason评分<7且分期<或=T2b，则精囊受累的可能性不大。相比之下，PSA水平高于20 ng/ml时，精囊受累的可能性很高。对于PSA水平在十至20 ng/ml之间且Gleason评分<7的患者，关于肿瘤体积和定位的超声检查结果将有助于确定靶区体积。在治疗计划中，当排除精囊时，直肠和膀胱的照射体积明显减少。
前瞻性使用这些客观标准将有助于选择精囊受累的患者，并且应该成为前列腺癌三维适形放疗的一个组成部分。
