γ射线体部立体定向放射联合内分泌治疗局限性与局部进展前列腺癌的临床疗效解剖.doc

γ射线体部立体定向放射联合内分泌治疗局限性与局部进展前列腺癌的前瞻性临床研究 【摘要】目的探讨γ体部立体定向放射联合内分泌治疗局限性与局部进展前列腺癌的治疗效果。方法 采用前瞻性随机对照研究。选择本院2004年6月-2009年6月期间收治的年龄≧70岁的局限性与局部进展前列腺癌患者96例，应用随机数字表法将纳入研究的患者分为对照组（单纯内分泌治疗）50例和实验组（γ体部立体定向放射联合内分泌治疗）46例，所有患者行药物去势,去势药物为康士得与抑那通。随访5年，比较两组患者5年生化无进展生存率、临床无进展生存率和总生存率，及不良反应发生情况。结果 对照组与研究组5年生化无进展生存率分别为54.2%（95%CI：45.3-63.1）和74.0%（95%CI：66.2-81.7），差异有统计学意义（χ2= 10.781，P = 0.001），但5年临床无进展生存率[64.2%（95%CI：57.2-71.1），69.1%（95%CI：60.9-77.2）]和总生存率[77.5%（95%CI：70.8-84.1），73.9%（95%CI：66.1-81.9）]差异无统计学意义（χ2= 1.067，P = 0.302；χ2= 0.808，P = 0.369）。两组主要不良反应为I级和Ⅱ级，未发现IV级不良反应，对照组5年累计发生不良反应14例，研究组累计不良反应25例，总累计不良反应发生率差异有统计学意义（χ2= 6.895，P =0.009）；但对照组和研究组Ⅲ级不良反应分别为2例和3例，差异未显示统计学意义（χ2=0.309，P = 0.579）。结论 γ体部立体定向放射联合内分泌治疗局限性与局部进展前列腺癌可以明显提高生化无进展生存率，不良反应轻，安全性较高，但对临床无进展生存率和总生存率还有待进一步深入研究。 【关键词】 局限性前列腺癌；局部进展前列腺癌；内分泌治疗；体部立体定向治疗；γ射线 Clinical efficacy of gamma-ray stereotactic body radiotherapy combined with hormonal therapy on localized high-risk prostate cancer LI Feng, WANG Su. [Abstract] Objective To explore the efficacy and safety of the gamma-ray stereotactic body radiotherapy combined with hormonal therapy on low-risk and middle-risk localized prostate cancer. Methods A prospective randomized study was applied. A total of patients enrolled in the study were randomly divided into the control group (endocrine therapy) 50 cases and the research groups (gamma-ray stereotactic body radiotherapy combined with hormonal therapy) 46 cases, then they treated with goserelin combined with bicalutamide program after surgical castration .the gamma-ray stereotactic body radiation therapy was applied in the research group. After Follow-up of 5 years, the five-year biochemical progression-free survival, clinical progression-free survival and overall survival, and adverse reactions in the two groups were compared. Results The 5-year biochemical progression-free survivals in the control group and the research group were 54.2% (95% CI: 45.3-63.1) and 74.0% (95% CI: 66.2-81.7) respectively. The difference was statis