(前列腺癌)。

P. Bey, V. Beckendorf, J. Stines
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引用次数: 0

摘要

以治疗为目的的前列腺癌放射治疗意味着在高剂量(至少66 Gy)下治疗整个前列腺。根据临床分期、PSA水平、Gleason评分,临床靶体积可包括精囊,较少见于盆腔淋巴结。显微镜下发现15 - 60%的T1-T2手术的囊外延伸,特别是在尖端肿瘤。相反,从过渡区发展的癌症可能局限于前列腺,即使它的体积很大,PSA水平也很高。前列腺分区解剖识别内部前列腺,包括过渡区(年轻人前列腺的5%)。外前列腺包括中央区和外周区。前列腺的下边界不低于耻骨联合的下边界。临床及影像学检查:超声、核磁共振(NMR)、ct扫描确定肿瘤体积、包膜渗出、精囊浸润、淋巴结扩张等预后因素。临床靶体积的确定现在主要是通过ct扫描来确定前列腺和精囊。核磁共振有助于更精确地识别前列腺顶点。临床靶体积边缘的定义必须考虑到每天的可重复性和器官运动当然还有器官的最大耐受剂量。
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[Prostate cancer].
Radiation therapy of prostate carcinoma with a curative intent implies to treat the whole prostate at high dose (at least 66 Gy). According to clinical stage, PSA level, Gleason's score, the clinical target volume may include seminal vesicles and less often pelvic lymph nodes. Microscopic extracapsular extension is found in 15 to 60% of T1-T2 operated on, specially in apex tumors. On contrary, cancers developing from the transitional zone may stay limited to the prostate even with a big volume and with a high PSA level. Zonal anatomy of the prostate identifies internal prostate, including the transitional zone (5% of the prostate in young people). External prostate includes central and peripheral zones. The inferior limit of the prostate is not lower than the inferior border of the pubic symphysis. Clinical and radiological examination: ultrasonography, nuclear magnetic resonance (NMR), CT-scan identify prognostic factors as tumor volume, capsule effraction, seminal vesicles invasion and lymph node extension. The identification of the clinical target volume is now done mainly by CT-Scan which identifies prostate and seminal vesicles. NMR could be helpful to identify more precisely prostate apex. The definition of margins around the clinical target volume has to take in account daily reproducibility and organ motion and of course the maximum tolerable dose for organs at risk.
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