前列腺癌的放射治疗
Radiotherapy of prostate cancer
放射治疗(放疗)是前列腺癌重要的治疗手段之一,现代放疗技术和根治性前列腺切除术在局限性前列腺癌治疗中可获得明显的无进展生存率,术后辅助放疗与随诊观察相比可显著降低根治性前列腺切除术后具有复发高危因素(精囊腺受侵、前列腺包膜外侵犯、广泛切缘阳性及术后持续PSA升高等)患者的PSA进展和局部复发风险.根治性前列腺切除术后生化复发或局部复发患者通过挽救性放疗可有效控制局部复发灶,降低远处转移风险和前列腺癌相关死亡风险.近年来的研究结果表明前列腺癌大分割放疗与传统常规分割放疗方案具有相同的肿瘤控制率,而晚期毒性并未明显增加.内分泌治疗与放疗的结合提高了局限性中危和高危前列腺癌的总生存率和无生化进展生存率.
更多Radiotherapy(RT) is one of the principle treatment options for prostate cancer.Modern RT and surgery show similar progression-free survival in localized prostate cancer.Adjuvant RT compared to observation significantly diminishes the risk of prostate-specific antigen (PSA) progression and local failure for patients at the highest risk for recurrence after radical prostatectomy,including with seminal vesicle invasion,extraprostatic extension,extensive positive margins,and detectable postoperative PSA.Salvage RT is effective at controlling local recurrence and reduces the risk of distant metastasis and prostate cancerspecific mortality (PCSM) for patients with PSA or local recurrence after prostatectomy.Hypofractionated radiotherapy of recent years' reports shows similar cancer control rates without an increased risk of late toxicity in comparison to conventional regimens.The addition of androgen-deprivation therapy (ADT) to radiation improves the overall survival and biochemical progression-free survival(bPFS) for intermediate-risk and high-risk patients.
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