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目的:报道X线三维适形放射治疗(简称3D CRT)治疗老年良性前列腺增生(BPH)的临床和影像学改变,讨论3D CRT对老年良性前列腺增生治疗效果。方法:利用单光子6MV的Elekta直线加速器的X放射线治疗在2006年2月-2010年2月期间新钢中心医院收治的37例患者。参与治疗的患者首先行热塑膜体位固定,行CT扫描,扫描层厚3 mm或5 mm,扫描所得数字图像信息被传递至治疗计划系统(TPS)进行图像重建,设计放疗计划,单靶区采用多角度照射。放疗分割次数为4~5次,每隔1 d进行1次,总治疗剂量20 Gy,增生的前列腺边缘外1 cm包括在95%的等剂量线范围内。结果:37例患者随访3~5年。治疗完成1个月后,37例出现尿频、尿急、尿痛的症状,程度不一。B超检查残余尿为(30±12)m L,跟治疗前比较有明显减少;3个月后有35例(94.6%)患者尿频、尿急、尿疼痛症状消失,还有2例患者有轻度尿频,占5.4%。B超检查中有少量残余尿液的有10例,全部患者行CT复查前列腺腺体体积较前变小或正常,患者症状依国际前列腺症状评分(IPSS),由治疗前(28.6±3.0)分下降至(8.2±2.0)分。结论:用三维适形放疗给予一定的放疗剂量作用于前列腺腺体细胞,使其变性、坏死,继而腺体缩小,起到消除或缓解前列腺老年良性增生尿路梗阻症状的目的。
OBJECTIVE: To report the clinical and radiographic changes in the treatment of benign prostatic hyperplasia (BPH) in elderly patients with X-ray three-dimensional conformal radiotherapy (3D CRT) and to discuss the effect of 3D CRT on the treatment of benign prostatic hyperplasia in the elderly. METHODS: Thirty-seven patients admitted to the New Steel Central Hospital between February 2006 and February 2010 using X-ray radiography with a single photon 6MV Elekta linear accelerator. Patients involved in the treatment of the first fixed-position thermoplastic film, CT scan, the scan thickness 3 mm or 5 mm, the scanned digital image information is passed to the treatment planning system (TPS) for image reconstruction, design of radiotherapy plans, single target area Multi-angle irradiation. Radiotherapy was performed 4 to 5 times a day, once every 1 day, with a total therapeutic dose of 20 Gy. Proliferation of 1 cm beyond the margins of the prostate was included within 95% of the isodose line. Results: 37 patients were followed up for 3 to 5 years. One month after the completion of treatment, 37 patients developed symptoms of pollakiuria, urgency and dysuria with varying degrees. B ultrasound examination of residual urine (30 ± 12) m L, compared with before treatment was significantly reduced; 3 months after 35 cases (94.6%) patients with urinary frequency, urgency, urinary pain symptoms disappear, there are 2 patients with Mild urinary frequency, accounting for 5.4%. B ultrasound examination in a small amount of residual urine in 10 cases, all patients underwent CT review prostate gland volume smaller or normal, the symptoms of patients with International Prostate Symptom Score (IPSS), from before treatment (28.6 ± 3.0) points Dropped to (8.2 ± 2.0) points. Conclusion: Radiotherapy with three-dimensional conformal radiotherapy given a certain dose of radiotherapy on prostate gland cells, degeneration, necrosis, followed by glands shrink, play to eliminate or alleviate the symptoms of benign prostatic hyperplasia in elderly patients with urinary tract obstruction.