前列腺癌放射治疗前沿进展

doi:10.3877/cma.j.issn.1674-3253.2025.05.002

前列腺癌（PCa）是我国老年男性泌尿生殖系统最常见的恶性肿瘤，发病率逐年上升。放射治疗是PCa最重要的治疗方法之一，精准放疗技术推动PCa放疗朝着更精准、更低毒、更高效的方向发展。在新型内分泌治疗、靶向治疗和核素治疗不断涌现的时代背景下，放射治疗在PCa不同阶段中的治疗地位仍稳固拓展，其临床应用包括局限期根治性放疗，术后辅助/挽救放疗，转移期减瘤性放疗等。本文综述了放射治疗在PCa不同阶段中的作用和最新研究进展，旨在为国内泌尿肿瘤领域同道提供参考。

关键词: 前列腺癌, 根治性放疗, 辅助放疗, 挽救性放疗, 减瘤性放疗, 精准放疗

Prostate cancer (PCa) is the most prevalent malignant tumor of genitourinary system in elderly men in China, with its incidence rate increasing annually. Radiotherapy remains one of the primary treatment options for PCa, and advancements in precision radiotherapy technology are driving the development of more accurate, less toxic, and more efficient treatments. Despite the emergence of new therapies such as endocrine therapy, targeted therapy, and nuclear therapy, the role of radiotherapy continues to expand across different stages of PCa. Its clinical applications include radical radiotherapy in the localized stage, postoperative adjuvant or salvage radiotherapy and cytoreductive radiotherapy in the metastatic stage. This article reviews the role of radiotherapy at various stages of PCa and highlights the latest research developments, aiming to provide valuable insights for colleagues in the field of urologic oncology.

Key words: Prostate cancer, Radical radiotherapy, Adjuvant radiotherapy, Salvage radiotherapy, Cytoreductive radiotherapy, Precision radiotherapy

表1 前列腺癌根治性放疗剂量提升相关随机临床研究

临床研究	例数	基线情况	放疗剂量	中位随访时间	研究终点	主要研究结果
MD Anderson study 2011^[5]	301	T₁~T₃，N₀，M₀， PSA≤10 ng/mL， PSA 10~20 ng/mL， PSA >20 ng/mL	70 Gy vs 78 Gy	15年	远处转移率(DM)，无生化复发或临床复发生存率(FFF)，疾病特异性死亡率(DSM)	70 Gy：81.1% FFF，78 Gy：88% FFF，(P=0.042)； 70 Gy：3.4% DM，78 Gy：1.1% DM，(P=0.018)； 70 Gy：6.2%DSM，78 Gy 3.2% DSM，(P=0.043)
PROG 95-09 2010^[6]	393	T_1b~T_2b，PSA≤15 ng/mL，低危患者（T_1~2a，PSA<10 ng/mL，GS评分≤6）占比75%	70.2Gy vs 79.2 Gy	8.9年	生化复发(BF)	所有患者： 70.2 Gy：32% BF，79.2 Gy：17% BF，(P<0.0001) 低危患者： 70.2 Gy：28% BF，79.2 Gy：7% BF，(P<0.0001)
Dutch randomised phase III trial 2014^[7]	843	T_1b~T₄	68 Gy vs 78 Gy	110月	10年无生化复发或临床复发生存率(FFF)	68 Gy：43% FFF，78 Gy：49% FFF，(P=0.045)
GETUG 06 2011^[8]	306	T_1b~T_3a, N₀，M₀ PSA <50 ng/mL	70 Gy vs 80 Gy	61月	生化复发(BF)	70 Gy：39% BF，80 Gy：28% BF
RTOG 0126 2018^[9]	1 532	T_1b~T_2b	70.2 Gy vs 79.2 Gy	100月	远处转移率(DM)，生化复发(BCF)	70.2 Gy：6% DM，79.2 Gy：4% DM，（P=0.05) 70.2 Gy：47% BCF，79.2 Gy：31% BCF，(P<0.001)

表1 前列腺癌根治性放疗剂量提升相关随机临床研究

临床研究	例数	基线情况	放疗剂量	中位随访时间	研究终点	主要研究结果
MD Anderson study 2011^[5]	301	T₁~T₃，N₀，M₀， PSA≤10 ng/mL， PSA 10~20 ng/mL， PSA >20 ng/mL	70 Gy vs 78 Gy	15年	远处转移率(DM)，无生化复发或临床复发生存率(FFF)，疾病特异性死亡率(DSM)	70 Gy：81.1% FFF，78 Gy：88% FFF，(P=0.042)； 70 Gy：3.4% DM，78 Gy：1.1% DM，(P=0.018)； 70 Gy：6.2%DSM，78 Gy 3.2% DSM，(P=0.043)
PROG 95-09 2010^[6]	393	T_1b~T_2b，PSA≤15 ng/mL，低危患者（T_1~2a，PSA<10 ng/mL，GS评分≤6）占比75%	70.2Gy vs 79.2 Gy	8.9年	生化复发(BF)	所有患者： 70.2 Gy：32% BF，79.2 Gy：17% BF，(P<0.0001) 低危患者： 70.2 Gy：28% BF，79.2 Gy：7% BF，(P<0.0001)
Dutch randomised phase III trial 2014^[7]	843	T_1b~T₄	68 Gy vs 78 Gy	110月	10年无生化复发或临床复发生存率(FFF)	68 Gy：43% FFF，78 Gy：49% FFF，(P=0.045)
GETUG 06 2011^[8]	306	T_1b~T_3a, N₀，M₀ PSA <50 ng/mL	70 Gy vs 80 Gy	61月	生化复发(BF)	70 Gy：39% BF，80 Gy：28% BF
RTOG 0126 2018^[9]	1 532	T_1b~T_2b	70.2 Gy vs 79.2 Gy	100月	远处转移率(DM)，生化复发(BCF)	70.2 Gy：6% DM，79.2 Gy：4% DM，（P=0.05) 70.2 Gy：47% BCF，79.2 Gy：31% BCF，(P<0.001)

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