Carcinoma of the prostate: Treatment with external radiotherapy
Carcinoma of the prostate: Treatment with external radiotherapy
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前列腺癌：外部放射治疗
作者：
L. Harisiadis;J. Senyszyn;P. Tretter;C. Chang;R. Veenema;P. Puchner;N. Romas;J. Lattimer;M. Tannenbaum
近年来，体外放疗已成为骨盆前列腺癌的主要治疗方法。在哥伦比亚长老会医疗中心接受外放疗的146例患者中，5年和10年生存率分别为64.1%和40.5%。A期患者的5年生存率为88.2%，B期为86.8%，C期为58%；分化程度高的患者为64.4%，未分化的患者仅为28.7%。IVP梗阻性改变患者的5年生存率为24.1%，而IVP无梗阻性改变患者的5年生存率为71.3%。诊断后6个月内开始放疗，5年生存率为70.3%，而延迟放疗，诊断后6个月以上，5年生存率为31.9%。辐射剂量大于或等于6500拉德的5年生存率为86.7%，而低于6500拉德的5年生存率为57.1%。以上差异均有统计学意义（p < 0.05）。经检查并发现影响预后的其他因素在一定程度上没有统计学意义，包括：患者接受放射治疗时的年龄、出现的症状、血清和骨髓中酸性磷酸酶的水平以及放射体积的大小。与其他发表的系列一致，并发症通常轻微，发生率低。肿瘤累及并突入尿道可能导致尿道狭窄的形成。用外部放射治疗局部控制这种癌症似乎很成功。治疗失败最常表现为远处转移伴或不伴局部复发，提示亚临床远处转移可能在放疗开始前就已经存在。对于有放射治疗适应症的前列腺癌，外部放射治疗似乎是治疗的选择，而不是近距离放疗。
In recent years external radiotherapy has been selected as primary treatment of patients with carcinoma of the prostate localized to the pelvis. Among 146 patients treated with external radiotherapy at Columbia‐Presbyterian Medical Center, the 5 and 10 year survival rates were 64.1% and 40.5%, respectively. The 5‐year survival rate was 88.2% for patients with Stage A, 86.8% for Stage B and 58% for Stage C; it was 64.4% for patients with more differentiated carcinomas, but only 28.7% for patients with undifferentiated tumors. Patients with obstructive changes on IVP had a 5 year survival rate of 24.1%, whereas, for patients with no obstruction on IVP, this rate was 71.3%. When radiotherapy started within 6 months after the diagnosis, the 5 year survival rate was 70.3%, whereas, a delay in starting radiotherapy, for more than 6 months after the diagnosis, was associated with a survival rate of 31.9%. Radiation dose of 6500 rad or more was associated with a 5‐year survival rate of 86.7%, whereas, for a dose of less than 6500 rad this survival rate was 57.1%. All the above differences were statistically significant (p < 0.05). Other factors that were examined and were found to influence the prognosis to a degree that was not statistically significant included: age of the patient at the time of radiotherapy, presenting symptoms, levels of acid phosphatase in the serum and in the bone marrow and size of the irradiated volume. In agreement with other published series the complications were usually mild and their incidence low. Tumor involving and protruding into the urethra may have contributed to the formation of urethral strictures. Local control of this cancer with external radiotherapy appears very successful. Treatment failures were manifested most often with distant metastases with or without local recurrence, suggesting that subclinical distant metastases might have been present prior to initiation of radiotherapy. External radiotherapy rather than brachyterhapy, appears to be the treatment of choice for cancer of the prostate with indications for radiotherapy.