前立腺癌の放射線療法

Abstract

stage C, pN1までの前立腺癌に速中性子線で32例, リニアックX線で9例の放射線療法を施行した.1) stage A2, B, C (D1を含む)の5年生存例は, 8/8, 6/6, 24/27.2)局所制御は速中性子線30/32, リニアックX線7/9で, 前者が良好であった.制御不十分例はいずれも原発巣の大きなstage Cであった.3)前立腺癌死は, リニアックX線例を除きすべてstaging operation未施行例であり, 照射野設定不良および低線量が原因と思われた.4)放射線療法後再発した時, 内分泌療法は2年後の判定で7/12例に有効であった.5)副作用は速中性子線の方が若干リニアックX線よりも多かったが, 一過性であった

Forty-one patients with adenocarcinoma of the prostate localized in the pelvis (stage A2, NX; 3, A2, pN0; 5, B, NX; 5, B, pN0; 1, C, NX; 13, C, pN0; 7, C, pN1; 7) underwent curative external radiotherapy. Thirty-two cases were treated by fast neutron combined with or without Liniac X-ray and 9 cases were treated by Liniac X-ray. Twenty-six cases were well controlled by radiotherapy, but 15 cases recurred and were followed by endocrine therapy. The types of recurrence were local growth in 3, distant metastases in 11, and both in 1. These recurrences occurred in the cases of large prostatic carcinoma, small radiation field in NX cases or low radiation dose. The five-year disease-free survival rates of stage A2, B, C were 86, 66, and 47%, respectively and the five-year overall survival rates were 100, 100, and 53%, respectively. The cases with well differentiated carcinoma had better prognosis than those with poorly differentiated carcinoma (p less than 0.05). As 58% of the cases which were given concomitant endocrine therapy were controlled for over 2 years, endocrine therapy seems to be effective in the cases of failure after radiotherapy. Most of the complications were slight and only one case with complication of sacral decubitus needed surgical treatment. It was concluded that external radiotherapy was a good modality for prostatic carcinoma localized in the pelvis.