This is a retrospective analysis of 225 patients with localized adenocarcinoma of the prostate who were treated with continuous-course external-beam radiation therapy at the University of Florida between October 1964 and August 1982. All patients were treated 5 or more years prior to the date of analysis, and 30% were eligible for 10-year follow-up. Hormonal treatment was used only in the management of recurrent disease. Ten-year results by stage were as follows: local control--A, 96%; B1, 92%; B2, 51%; C1, 57%; C2, 76%. Relapse-free survival--A, 96%; B1, 58%; B2, 38%; C1, 43%; C2, 61%. Absolute survival--A, 69%; B1, 29%; B2, 47%; C1, 35%; C2, 50%. Freedom from distant metastasis--A, 100%; B1, 55%; B2, 71%; C1, 65%; C2, 77%. Tumor grade was an important prognostic variable in most of the subgroups analyzed. The 5-year rate of distant metastasis was significantly greater in patients with stage C disease when the biopsy was made by transurethral resection of the prostate (TURP) rather than by needle biopsy. In stage B patients, the biopsy method was not prognostically important. For the 48 patients who developed recurrent tumor in the prostate gland, with or without concurrent metastasis, the 5-year absolute survival rate calculated from the date of recurrence was 26%, compared with 10% for the 34 patients who developed distant metastasis alone. Severe complications developed in 5 out of 225 patients (2%) and included three severe rectal injuries, one bladder neck contracture, and one femoral head necrosis. Moderate complications developed in 48 out of 225 patients (21%), with rectosigmoiditis (8%) and hematuria (5%) being the most common problems. For both moderate and severe complications, there was a clear trend toward an increasing complication rate with increasing dose. The method of diagnosis appeared to be a factor in the development of urinary incontinence following irradiation: needle biopsy, 0/106 (0%); TURP, 3/112 (3%); subtotal prostatectomy, 1/7 (needle biopsy versus TURP or prostatectomy, p = 0.076). The frequency of peripheral edema following irradiation was influenced by a history of surgical disruption of the pelvic lymphatics: staging lymphadenectomy, 2/16 (13%), versus no lymphadenectomy, 0/209 (p = 0.005). A comparison with other series is presented.

译文

这是对1964年10月至1982年8月之间在佛罗里达大学接受连续病程外束放射疗法治疗的225例前列腺局部腺癌患者的回顾性分析。所有患者在分析日期之前接受了5年或更长时间的治疗,并且30% 有资格进行10年的随访。激素治疗仅用于治疗复发性疾病。按阶段分列的十年结果如下: 局部对照-A,96%; B1,92%; B2,51%; C1,57%; C2,76%。无复发生存率-A,96%; B1,58%; B2,38%; C1,43%; C2,61%。绝对生存 -- A,69%; B1,29%; B2,47%; C1,35%; C2,50%。免于远处转移-A,100%; B1,55%; B2,71%; C1,65%; C2,77%。在大多数分析的亚组中,肿瘤分级是重要的预后变量。当通过经尿道前列腺切除术 (TURP) 而不是通过穿刺活检进行活检时,C期疾病患者的5年远处转移率显着更高。在B期患者中,活检方法对预后不重要。对于48例在前列腺中发生复发性肿瘤并伴有或不伴有转移的患者,从复发之日起计算的5年绝对生存率为26%,而34例仅发生远处转移的患者为10%。225例患者中有5例 (2% 例) 出现严重并发症,包括3例严重的直肠损伤,1例膀胱颈挛缩和1例股骨头坏死。225例患者中有48例 (21% 例) 出现中度并发症,其中直肠乙型炎 (8%) 和血尿 (5%) 是最常见的问题。对于中度和重度并发症,随着剂量的增加,并发症发生率明显增加。诊断方法似乎是放疗后尿失禁发展的一个因素: 穿刺活检,0/106 (0%); TURP,3/112 (3%); 前列腺次全切除术,1/7 (穿刺活检与TURP或前列腺切除术,p = 0.076)。照射后外周水肿的频率受盆腔淋巴管手术破裂史的影响: 分期淋巴结清扫术,2/16 (13%),而没有淋巴结清扫术,0/209 (p = 0.005)。提出了与其他系列的比较。

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