CAJ | 학술논문

目的：总结射波刀放疗治疗前列腺癌的临床应用经验和近期疗效。方法回顾性分析2012年5月至2013年9月收治的34例前列腺癌患者行射波刀放疗治疗的资料，年龄54～84岁，平均73岁。均采用第4代射波刀放疗系统（立体定向放射手术平台）进行治疗。本组中，24例为初始根治性放疗联合内分泌治疗（A组），其中5例加做盆腔局部放疗；5例为初始根治性放疗（B组）；5例为临床局限性前列腺癌内分泌治疗期间PSA上升或进入去势抵抗性前列腺癌（ CRPC）阶段后放疗（C组），其中1例加做盆腔局部放疗。所有患者均经前列穿刺活检病理确诊为前列腺癌。治疗前PSA 0．20～100．00μg/L，中位数为17．74μg/L，其中 A 组 PSA 6．60～100．00μg/L，中位数为19．80μg/L；B组PSA 9．43～75．50μg/L，中位数为12．50μg/L；C组PSA 0．20～15．08μg/L，中位数为0．67μg/L。治疗前Gleason评分≤6分6例，7分13例，≥8分12例，3例未获得Gleason评分。射波刀放疗前1周在经直肠超声引导下行前列腺穿刺放置金标并通过CT检查定位。射波刀放疗总剂量为36．25～37．50 Gy，分5次进行，隔日照射。结果33例治疗后1、3、6个月的PSA值均明显下降， PSA中位数分别为0．83、0．10、0．07μg/L。1例CRPC辅助放疗患者PSA未下降，1、36、个月的PSA中位数分别为14．50、20．003、8．00μg/L。治疗后1、3、6个月时A组PSA分别为0．14、0．05、0．02μg/L；B组分别为6．35、4．30、1．20μg/L；C组分别为0．28、0．22、0．13μg/L。34例中2例在治疗中出现尿痛、轻微血尿，1例出现便血。结论射波刀放疗对前列腺癌的近期疗效确切，其远期疗效和安全性有待于进一步观察随访。
목적：총결사파도방료치료전렬선암적림상응용경험화근기료효。방법회고성분석2012년5월지2013년9월수치적34례전렬선암환자행사파도방료치료적자료，년령54～84세，평균73세。균채용제4대사파도방료계통（입체정향방사수술평태）진행치료。본조중，24례위초시근치성방료연합내분비치료（A조），기중5례가주분강국부방료；5례위초시근치성방료（B조）；5례위림상국한성전렬선암내분비치료기간PSA상승혹진입거세저항성전렬선암（ CRPC）계단후방료（C조），기중1례가주분강국부방료。소유환자균경전렬천자활검병리학진위전렬선암。치료전PSA 0．20～100．00μg/L，중위수위17．74μg/L，기중 A 조 PSA 6．60～100．00μg/L，중위수위19．80μg/L；B조PSA 9．43～75．50μg/L，중위수위12．50μg/L；C조PSA 0．20～15．08μg/L，중위수위0．67μg/L。치료전Gleason평분≤6분6례，7분13례，≥8분12례，3례미획득Gleason평분。사파도방료전1주재경직장초성인도하행전렬선천자방치금표병통과CT검사정위。사파도방료총제량위36．25～37．50 Gy，분5차진행，격일조사。결과33례치료후1、3、6개월적PSA치균명현하강， PSA중위수분별위0．83、0．10、0．07μg/L。1례CRPC보조방료환자PSA미하강，1、36、개월적PSA중위수분별위14．50、20．003、8．00μg/L。치료후1、3、6개월시A조PSA분별위0．14、0．05、0．02μg/L；B조분별위6．35、4．30、1．20μg/L；C조분별위0．28、0．22、0．13μg/L。34례중2례재치료중출현뇨통、경미혈뇨，1례출현편혈。결론사파도방료대전렬선암적근기료효학절，기원기료효화안전성유대우진일보관찰수방。
Objective To evaluate initial outcome and summarize the clinical experience of prostate cancer treat by CyberKnife. Methods From May.2012 to Sept.2013, 34 prostate cancer patients were treated with radiotherapy by the fourth generation Cyberknife system ( stereotactic radiosurgery platform ) . The mean age of patients was 73.4 (54-84) years.24 cases initially treated with radical radiotherapy were combined with hormonal therapy (group A), 5 cases were initially treated with radical radiotherapy (group B) , 5 cases with clinically localized prostate cancer and PSA rising during the hormonal therapy or entered CRPC stage were treated by Cyberknife (group C).5 of the 24 cases and 1 of the 5 cases with clinically lo-calized prostate cancer with PSA rises during the hormonal therapy or entered CRPC stage treat by Cy -berknife received pelvic radiotherapy before the treatment. The median PSA before radiotherapy was 17.74 (0.20-100.00) μg/L.The median PSA of group A before radiotherapy was 19.80(6.60-100.00) μg/L. The median PSA of group B before radiotherapy was 12.50( 9.43-75.50) μg/L.The median PSA of group C before radiotherapy was 0.67 (0.20-15.08) μg/L.6 cases of Gleason ≤6, 13 cases of Gleason=7, 12 ca-ses of Gleason≥8, three patients failed to get the Gleason score before the treatment .Four gold fiducials were implanted into prostate guided by transrectal ultrasound 1 week before the radiotherapy .A total dose of 36.25-37.50 Gy delivered in five fractions. Results The PSA of 33 cases decreased significantly at 1, 3 and 6 months after the treatment , and the median PSA were 0.83 , 0.10 and 0.07μg/L.One case′s PSA did not decrease.The median PSA of the group A at 1, 3 and 6 months were 0.14, 0.05 and 0.02 μg/L.The effects of radiation needed to be evaluated when the hormonal therapy ended .The median PSA of the group B at 1, 3 and 6 months were 6.35, 4.30, and 1.20μg/L.The median PSA of group C at 1, 3 and 6 months were 0.28, 0.22 and 0.13μg/L.2 cases had dysuria , mild hematuria during the treatment .1 case had mild rectal bleeding during treatment .C onclusions The therapeutic effect of radiotherapy for prostate cancer de-livered by CyberKnife is excellent .Its long-term efficacy and safety need to be further evaluated .