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目的探讨局限性前列腺癌根治性三维适形放射治疗(3DCRT)的靶区设计与正常组织的保护。方法103例经病理证实的前列腺癌病人,T1-3N0M0,其中:T1:19例;T2:70例;T3:16例。平均年龄69.6岁。Gleason≥7:39例;PSA≥10:69例。所有病人接受直线加速器10MVX线全程三维适形放疗(3DCRT),设定两个临床靶体积(CTV)即CTV1包括前列腺和精囊和CTV2只包括前列腺腺体。相应治疗靶体积(PTV1和PTV2)分别是在相应CTV基础上外放15mm,在与直肠交界处减少5mm。危险器官直肠壁5mm,膀胱7mm。处方剂量PTV1最小剂量为45~50.4Gy,PTV2为70~73.8Gy(75.5Gy在ICRU剂量点)。结果中位随访时间23.5个月,出现16例(13.5%)和8例(7.8%)膀胱和直肠Ⅱ级反应,无膀胱和直肠Ⅲ级反应。结论局限性前列腺癌的三维适形放疗技术可有效减少膀胱与直肠组织受照体积与剂量,相邻组织器官的不良反应发生率低,提高患者治疗顺应性,有利于提高前列腺局部放疗剂量,提高局部控制率和患者生活质量。
Objective To investigate the target design and the protection of normal tissue in radical three-dimensional conformal radiation therapy (3DCRT) for localized prostate cancer. Methods 103 cases of pathologically confirmed prostate cancer patients, T1-3N0M0, including: T1: 19 cases; T2: 70 cases; T3: 16 cases. The average age of 69.6 years old. Gleason≥7: 39 cases; PSA≥10: 69 cases. All patients underwent 3-dimensional conformal radiotherapy (3DCRT) with 10 MVX line of linear accelerator. CTV1 including CTV1 including prostate and seminal vesicle and CTV2 including prostate gland only were set for two clinical target volumes. The corresponding therapeutic target volumes (PTV1 and PTV2) were respectively 15 mm extrinsic to the corresponding CTV and 5 mm reduction at the junction with the rectum. Dangerous organ rectal wall 5mm, bladder 7mm. Prescription dose PTV1 minimum dose of 45 ~ 50.4Gy, PTV2 of 70 ~ 73.8Gy (75.5Gy at ICRU dose point). Results The median follow-up time was 23.5 months. There were 16 cases (13.5%) and 8 cases (7.8%) of bladder and rectum grade Ⅱ reaction without grade Ⅲ bladder and rectum reaction. Conclusions Three-dimensional conformal radiotherapy for localized prostate cancer can effectively reduce the volume and dose of irradiation in the bladder and rectum. The incidence of adverse reactions in adjacent tissues and organs is low, and the therapeutic compliance of patients is improved. It is also beneficial to improve the local radiotherapy dose of prostate Local control rate and patient quality of life.