Objective To investigate the long-term outcome and safety of prostate cancer patients treated with intensity-modula-ted radiotherapy( IMRT) reduced clinical target volume( CTV) . Methods From Jan. 2006 to Jun. 2010,78 patients with prostate cancer were treated with IMRT. Total dose was 72. 6 Gy,2. 2 Gy per fraction, 33 fractions. The indexes of clinical observation including acute and chronic injury, overall survival(OS), freedom from biochemical(FFB), progression-free survival(PFS), distant metastasis-free survival ( DMFS) . Cox regression model was used to evaluate the risk factors predicting the prognosis. Results The volume of tumor according our protocol and RTOG were (274. 21±92. 64) cm3 and (600. 68±113. 72) cm3, separately, and the differences were statistically signifi-cant( P<0. 05) . All patients were completed on schedule radiotherapy, bone marrow suppression was in grade 1, acute urinary injury was mostly in grade1-2, and the intestinal damage priority was in grade 1. By December 31, 2014, the 5 years follow-up rate was 91. 0%. The 5-year survival rate, 5-year progression-free survival rate, 5-year freedom from biochemical rate and distant metastasis-free survival rate were 82. 1%,79. 4%,84. 6% and 94. 9%, respectively. Cox's proportional hazards regression model showed age,PSA,ECOG score and Gleason score were the independent risk factors of OS and PFS. Conclusion The reduced CTV can gain comfortable survival benefit, and it can reduce acute and chronic injury, meanwhile, it can protect hematopoietic function of patients.%目的 探讨小靶区调强放疗治疗期前列腺癌的疗效及安全性.方法 收集2006年1月至2010年6月间78例前列腺癌患者接受自定义小靶区调强放疗,DT 72.6 Gy,2.2 Gy/f,共33次.观察患者急性和慢性放射性反应、总生存时间(OS)、无生化复发率、无进展生存时间(PFS)、无远处转移率,Cox比例风险回归模型评价影响预后的危险因素.结果 小靶区定义和RTOG定义的肿瘤体积分别为(274.21±92.64)cm3和(600.68±113.72)cm3,差异有统计学意义(P<0.05).所有患者均能完成放疗计划,骨髓抑制以1级为主,急性泌尿系统损伤大多为1~2级,放射性肠道损伤以1级为主.随访截止于2014年12月31日,随访率为91.0%,患者的5年生存率、无进展生存率、无生化复发率和无远处转移率分别为82.1%、79.4%、84.6%和94.9%.年龄、PSA水平、ECOG评分、Gleason评分是影响患者OS和PFS的独立危险因素.结论 前列腺癌患者小靶区外照射生存率高,亦可减轻急慢性放射性反应,同时能保护患者的造血功能.
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