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題 名 | 早期攝護腺癌之手術治療與放射治療及其預後因子=The Impact of Radical Prostatectomy and Radiotherapy in Biochemical Relapse for Stage T1-T2 Prostate Cancer |
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作 者 | 張國楨; 張慶雄; 胡渝昌; 陳建勳; | 書刊名 | 放射治療與腫瘤學 |
卷 期 | 12:1 2005.03[民94.03] |
頁 次 | 頁1-7 |
分類號 | 416.275 |
關鍵詞 | 局部攝護腺癌; 放射線治療; 攝護腺根除性摘除手術; 攝護腺特異抗原; Local prostate cancer; Radiotherapy; Radical prostatecomy; PSA; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:以攝護腺特異抗原(prostate specific antigen, PSA),回溯分析(retrospective analysis),比較臨床分期為T1-T2的局部攝護腺癌,接受放射線治療(radiation therapy)與攝護腺根除性摘除手術(radical prostatectomy)的治療結果。 材料與方法:從1991年7月至2003年7月,共有235位臨床分期為T1-T2的早期攝護腺癌病人,在本院接受放射線治療或攝護腺根除性摘除(radical prostatectomy)治療。所有的病人都有治療前的血中PSA濃度、切片的格里森分數(Gleason score)、治療前的賀爾蒙治療不超過六個月,局部治療後沒有再給予其他的輔助治療。共有119位(50.6%)接受徹底根除手術,手術後邊緣有殘餘病灶者不列入本研究的對象;接受體外放射線治療劑量小於70Gy者共有52位(22.1%);大於等於70Gy者共有38位(16.2%);體外放射線治療合併近接治療者共有19位(8.1%);另外有7位(3%)接受經尿道攝護腺切除手術後加體外放射線治療。放射線治療劑量小於70Gy與大於70Gy的中值劑量分別是65.6Gy及70.2Gy。所有病人的中值追蹤時間為41.9個月。PSA值可作為對治療反應的指標,治療後PSA值多會下降,如果不正常的升高,有可能局部復發或疾病惡化(disease progression)。臨床上都以PSA值判斷攝護腺癌預後之好壞或治療後追蹤檢查疾病有無持續存在(persistent disease)或復發(relapse)。 本研究是以臨床T分期、治療前的血中PSA濃度、Gleason分數、治療模式等變數對生化性無復發存活率(biochemical relapse free survival, bRFS),作多項變數分析。 結果:手術與放射線治療的5年bRFS(5-year biochemical relapse free survival)分別是53.5%與59.0%,7年bRFS分別是21.3%與45.0%,多變數分析顯示手術前的血中PSA濃度(p=0.029) 與Gleason分數(p=0.006)是獨立的復發預後因子,治療模式(p=0.25)與臨床T分期(p=0.53)不是PSA復發的獨立預後因子。 結論:T1-T2的局部攝護腺癌,與根除性摘除手術比較,放射線治療也有相當的治療結果,對於PSA復發的影響沒有統計上的意義。 |
英文摘要 | Purpose: This retrospective analysis reviewed the biochemical relapse free survival rates after treatment with radiotherapy or radical prostatectomy (RP) for clinical stage T1-T2 localized prostate cancer. Methods and Materials: The study population comprised 235 patients treated at either Urology section or Radiation Oncology section in our institution. All patients had pretreatment prostate-specific antigen (iPSA) levels and biopsy Gleason scores (bGSs) Neoadjuvant androgen block treatment was given for less than 6 months. No adjuvant therapy was given after local therapy. 119 patients (50.6%) had undergone radical prostacteomy (RP). 52 patients (22.1%) received EBRT<70 Gy, 38 patients (16.2%) received EBRT≧70 Gy, 7 patients (3%) were treated with post TURP radiotherapy and combined interstitial and radiotherapy was delivered for 19 patients (8.1%). Only patients with free surgical margin were enrolled in the group of RP. The median readiation doses in EBRT<70 Gy and EBRT≧70 Gy was 65.6Gy and 70.2Gy, respectively. The median follow-up time for all patients was 41.9 months. Biochemical relapse was defined as two consecutive PSA>0.2ng/ml for RP and three consecutive rising PSA levels (American Society for Therapeutic Radiology Oncology consensus definition) for all other cases. Cox regression multivariate analysis was performed using clinical T stage, bGS, iPSA and treatment modality. Results: The 5-year bRFS (biological relapse free survival) for RP and radiotherapy was 53.5% and 59% respectively. The 7-year bRFS for RP and radiotherapy was 21.3% and 45% respectively. Multivariate analysis showed iPSA (p=0.029) and bGS (p=0.006) to be independent predictors of relapse. Treatment modality and clinical T stage were not independent predictors of relapse. Conclusion: There was no significant difference between RP and radiotherapy in the view of biochemical relapse for stage T1-T2 prostate cancer. |
本系統中英文摘要資訊取自各篇刊載內容。