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

陳妙芬(Miao-Fen Chen) ； 陳文政(Wen-Cheng Chen) ； 梁為民(Wei-Man Leung) ； 張慧朗(Phei-Lang Chang) ； 朱聖賢(Sheng-Hsien Chu) ； 莊正鏗(Cheng-Keng Chuang) ； 廖宗琦(Chaung-Chi Liaw) ； 林永昌(Yung-Chang Lin) ； 吳俊德(Jun-Der Wu) ； 洪志宏(Ji-Hong Hong)

《放射治療與腫瘤學》 5卷4期 (1998/12) Pp. 233-243

https://doi.org/10.6316/TRO/199805(4)233

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），中值追蹤期為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問治療計劃方式，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屢管、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GrouPⅡ(4/9, 44%)，與國外文獻相比明顯較高。接受開刀沒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（ρ=0.004，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%；GrouPⅡ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。

關鍵字

攝護腺癌 ； 放射治療 ； 副作用

並列摘要

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 7.8 -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 (01) and genitourinary (GU) toxicity were observed in 28 (38%) and 18 (25%) patients, respectively. There were one patient with acute grade III 01 toxicity and another patient with acute grade 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 Dl 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 survivals.
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.

並列關鍵字

Prostate cancer ； Radiotherapy ； Complication