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目的:比较单纯螺旋断层放疗与螺旋断层放疗联合射频热疗治疗局部晚期前列腺癌的近期疗效及急性毒副反应。方法:70例T3N0M0-T4N1M0期前列腺癌患者中52例放疗前接受手术去势,18例接受药物去势。随机将70例患者分为对照组(单纯螺旋断层放疗)与实验组(螺旋断层放疗联合射频热疗),其中对照组36例,实验组34例,比较两组患者治疗结束后的有效率、血清前列腺特异性抗原(prostate specific antigen,PSA)水平变化及急性毒副反应。结果:所有患者均按计划完成治疗。对照组和实验组病灶完全缓解率(CRR)分别达27.8%(10/36)和29.4%(10/34),部分缓解率(PRR)分别达33.3%(12/36)和52.9%(18/34),两组总有效率(CRR+PRR)分别为61.1%和82.4%,实验组的总有效率显著高于对照组(P<0.05)。经不同方案治疗后,两组患者血清PSA水平均有明显降低,且实验组血清PSA水平显著低于对照组,差异有统计学意义(P<0.01)。参考RTOG急性放疗相关毒副反应分级标准,对照组和实验组1-2级急性泌尿道毒副反应发生率分别为41.7%(15/36)和44.1%(15/34),1~2级急性肠道毒副反应发生率分别为50.0%(18/36)和47.1%(16/34),骨髓抑制反应1~2级的发生率分别为33.3%(12/36)和29.4%(10/34)。对照组未出现3级以上急性不良反应,实验组1例出现3级泌尿道反应(血尿),两组间各急性毒副反应无明显差异(P>0.05)。结论:联合射频热疗可以显著提高螺旋断层放疗对局部晚期前列腺癌患者的近期疗效,且无增加患者急性毒副反应的风险,具有临床推广价值。
Objective: To compare the short-term curative effect and acute toxicities and side effects of simple helical and radiotherapy combined with radiofrequency thermotherapy in the treatment of locally advanced prostate cancer. Methods: Totally 52 cases of T3N0M0-T4N1M0 prostate cancer were surgically treated before radiotherapy and 18 cases were treated with drug castration. Seventy patients were randomly divided into control group (spiral CT) and experimental group (spiral CT combined with radiofrequency hyperthermia), of which 36 cases in the control group and 34 cases in the experimental group were compared. The effective rate was compared between the two groups after treatment, Serum level of prostate specific antigen (PSA) and its acute toxicity. Results: All patients completed the treatment as planned. The CRR was 27.8% (10/36) and 29.4% (10/34) in the control group and the experimental group, respectively. The partial response rates (PRRs) were 33.3% (12/36) and 52.9% (18% / 34). The total effective rate (CRR + PRR) of the two groups were 61.1% and 82.4% respectively. The total effective rate of the experimental group was significantly higher than that of the control group (P <0.05). After treatment with different regimens, serum PSA levels decreased significantly in both groups, and serum PSA levels in the experimental group were significantly lower than those in the control group (P <0.01). According to RTOG acute toxicity-related toxic and side effects classification criteria, the incidences of acute urinary tract toxicity in control group and experimental group were 41.7% (15/36) and 44.1% (15/34), respectively, The incidences of acute side effects were 50.0% (18/36) and 47.1% (16/34), respectively. The incidences of myelosuppression grade 1 to 2 were 33.3% (12/36) and 29.4% (10%) respectively / 34). There were no grade 3 or more acute adverse reactions in the control group and no grade 3 urinary tract reaction (hematuria) occurred in 1 case in the experimental group. There was no significant difference in acute side effects between the two groups (P> 0.05). Conclusions: Combined radiofrequency thermotherapy can significantly improve the short-term curative effect of spiral CT on patients with locally advanced prostate cancer without increasing the risk of acute toxic and side effects, which is of clinical value.