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題 名 | 攝護腺癌之傳統放射線治療--長庚紀念醫院十四年之經驗=The Treatment of Prostate Cancer by Conventional Radiation Therapy-A 14 Years Experience in Chang Gung Memorial Hospital |
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作 者 | 陳妙芬; 陳文政; 梁為民; 張慧朗; 朱聖賢; 莊正鏗; 廖宗琦; 林永昌; 吳俊德; 洪志宏; | 書刊名 | 放射治療與腫瘤學 |
卷 期 | 5:4 1998.12[民87.12] |
頁 次 | 頁233-243 |
分類號 | 416.275、416.275 |
關鍵詞 | 攝護線癌; 放射治療; 副作用; Prostate cancer; Radiotherapy; Complication; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:為了探討傳統放射線治療攝護腺癌的結果,因此回溯分析14年來於本科接 受放射線治療之攝護腺癌病例。 材料與方法:自 1982 至 1996 年,共有 240 位攝護腺癌 病患被轉介至本科接受放射治療。 僅有腫瘤局限在骨盆腔 (分期 A-D1) 且完成治療的 73 位病患才進入最後分析。這 73 位病患中有 1 位為 A 期、23 位為 B 期、35 位為 C 期、 12 位為 D1 期、2 位未知。 病患的中值年齡為 67 歲 (範圍 53- 78 歲 ),中值追�j期為 38.5 個月 (範圍 7.8-124 個月 )。為了便於分析,我們將病患分為二組: Group Ⅰ - 接 受治癒性放射線治療,共有 64 位;Group Ⅱ接受根除性攝護腺切除及輔助性放射治療,共 有 9 位。 原則上放射線治療方式是採傳統二度空間治療計劃方式, 用高能放射線 (10-15MV) 先照射骨盆腔至 4400cGy,再縮小範圍照射貯精囊及攝護腺。Group Ⅰ總劑量達 4400-8400 cGy( 平均值 6638 cGy), Group Ⅱ劑量則至 5600-6800 cGy( 平均值 5956 cGy)。共有 35 位病患,接受輔助性的荷爾蒙治療。結果:這 73 位病患治療的早期副作用 :28(38%) 位有第二級的腸胃道症狀,18 位 (25%) 有第二級的泌尿道症狀。1 位有第三級 的腸胃道症狀,1 位有第三級的泌尿道症狀。在治療的晚期作用方面;產生嚴重併發症包括 廔管、尿道狹窄、膀胱炎、直腸炎共 9 位 (14%);其中 5 位為 Group Ⅰ (5/55, 9%),4 位為Group Ⅱ (4/9,44%),與國外文獻相比明顯較高。 接受開刀及輔助性放射治療的病患產 生晚期嚴重併發症的比例,明顯較單純接受放射治療的病人為高 (p=0.0004,卡方統計 )。 這 73 位病患 5 年整體存活率為 67%,10 年為 36%; 5 年疾病專屬存活率為 66%,10 年 為 34%。 Group Ⅰ中分期 A、B 者局部控制率為 83%、分期 C 為 90%,分期 D1 為 50%; Group Ⅱ則為 100%。 分期、年齡、病理分級、荷爾蒙治療、放射線治療總劑量在單變因分 析中發現,對疾病專屬存活率皆沒有統計學上有意義的影響。結論:本篇研究顯示治癒性放 射線治療或根除性攝護腺切除加上輔助性放射治療,對攝護腺癌可得到良好之局部控制;但 採用傳統二度空間治療計劃方式,副作用明顯偏高。因此建議攝護腺癌的放射線治療宜採用 三度空間順形治療,以減少其副作用。 |
英文摘要 | Purpose:To evaluate the result of conventional radiation treatment for prostate cancer, we performed a retrospective analysis of patients referred to our department from 1982 to 1996. Material and Methods:From 1982 to 1996, a total of 240 prostate cancer patients were referred to our department for radiotherapy (RT). Only 73 patients who had disease confined to the pelvis (stage A-D1) and completed the RT treatment were entered into this analysis. The median age was 67 years (range 53-78) and the median follow-up time was 38.5 months (range 738-124.3). For convenience for comparison, we divided those patients into two groups for final analysis:group Ⅰ -curative RT alone, 64 patients; group Ⅱ -radical prostatectomy followed by adjuvant RT, 9 patients. Radiotherapy was delivered by conventional two-dimensional treatment plan. External irradiation was usually given by 10 or 15 MV X-ray to the pelvis and then coned down to the prostate and seminal vesicle, yielding a total dose of 4400 to 8400 cGy (mean 6638 cGy) for group Ⅰ patients and 5600 to 6800 cGy( mean 5956 cGy) for group Ⅱ patients. Adjuvant or neoadjuvant hormone therapy was given in 33 patients. Results: Grade Ⅱ acute gastrointestinal (GI) and genitourinary (GU) toxicity were observed in 28 (38%) and 18 (25%) patients, respectively. There were one patient with acute group Ⅲ GI toxicity and another patient with acute group Ⅲ GU toxicity. Late morbidity analysis was only available in 66 patients. Severe late complications including fistula formation, urethral stricture, cystitis, proctitis were found in 9 patients (14%) which is higher than other reported series. Those patients who received RT after radical prostatectomy experienced a significant higher severe late complication rate than those who received RT alone. (44% vs 9%, p<0.05). The overall survival rates for all patients are 67% at 5 years and 36% at 10 years. The cause-specific survivals for all patients are 66% at 5 years and 34% at 10 years. The local control rates are 83% for stage A and B, 90% for stage C and 50% for stage D1 patients in group Ⅰ. The local control rate for group Ⅱ patients is 100%. In univariate analysis, age, stage, pathology grading, hormone therapy and RT dose didn't show significant impact on cause specific sruvivals. Conclusion:This study showed the local control rates after curative RT or radical prostatectomy followed by adjuvant RT are good. However, the complication rates after conventional two-dimensional RT are high. Further efforts in three-dimensional conformal RT for prostate cancer is highly recommended in term of decreasing toxicity. |
本系統中英文摘要資訊取自各篇刊載內容。