目的：我們進行這個回溯性分析，以探討罹患攝護腺癌的病人接受強度調控放射線治療後之預後因子及治療結果。材料和方法：本研究包含了142位攝護眼病人，其於西元2003年12月至2006年12月期間，在台灣大學附設醫院接受強度調控放射線治療。給予clinical target volume (CTV)的總放射線劑量之中位數為78Gy(73.1-82.3Gy)，以單次劑量1.91-2.11Gy，一周五天，每天一次的方式照射。有136位病人接受了前置的輔助性荷爾蒙治療通常在放射線治療前一至三個月間開始。總存活率是以Kaplan-Meier方法分析，對存活率可能造成明顯差異的預後因子則分別以log-rank test及Cox regression進行單變數及多變數分析。结果：追蹤時間之中位數為24.3個月。兩年的整體存活率為95.4%。兩年的無病存活率，PSA無升高存活率，及無遠端轉移存活率，分別為87.1%，85.9%，及97.6%。兩年的無病存活率和PSA無升高存活率會隨著腫瘤期別，分化程度(Gleason score)，及治療前之PSA數值的嚴重度增加而降低。兩年的無遠端轉移存活率，則會受到腫瘤期別，及分化程度的影響。多變數分析顯示腫瘤期別為獨立影響PSA無升高存活率(p=.040)及無病存活率(p=.050)的因子，而只有分化程度為獨立影響無遠端轉移存活率(p=.037)的因子。在17個產生的A升高的復發病人當中，其兩年的無遠端轉移存活率，會顯著的受到從PSA低點至PSA復發之間的時間長短的影響（≤6個月為50.0%'，>6個月為84.6%，p=.049）。急性grade2的腸胃及泌尿方面的副作用發生率分別為16.8%及14%。長期grade2的腸胃及泌尿方面的副作用發生率則分別為12.6%及6.3%。有3位病人(2.1%)產生長期grade3的腸胃副作用。而使用直腸內擴張氣球能降低發生長期grade3的腸胃副作用的機率（未使用者為7.14%，使用者為0%，p=.046）。结论：接受強度調控放射線治療的攝護腺癌病人，其兩年的無病存活率及PSA無升高存活率，會受到腫瘤期別，治療前之PSA數值，及分化程度而影響預後。無遠端轉移存活率後之預後因子則包括腫瘤期別，分化程度，及從PSA低點至PSA復發之間的時間長短。

Purpose: We performed this retrospective analysis to evaluate prognostic factors and short-term outcome for patients with prostatic adenocarcinoma receiving definitive intensity-modulated radiotherapy (IMRT). Material and Method: This study included 142 patients who underwent definitive IMRT at National Taiwan University Hospital between December 2003 and December 2006. The median dose to the clinical target volume was 78 Gy (range: 73.1-82.3 Gy) in daily fractions of 1.91-2.11 Gy. Neoadjuvant hormonal therapy was given to 136 patients, usually starting 1 to 3 months before IMRT. The survival outcome was estimated using Kaplan-Meier method, and univariate and multivariate analyses were made with Log-rank test and Cox regression, respectively, on potential prognostic factors for survival. Results: The median follow-up time was 24.3 months. The 2-year overall survival (OS) was 95.4%. The 2-year failure-free survival (FFS), biochemical failure-free survival (BFFS), and distant metastasis-free survival (DMFS) rates for the whole cohort were 87.1%, 85.9%, and 97.6%, respectively. The 2-year FFS and BFFS were adversely influenced by T stage, Gleason score (GS) >7, and initial PSA (iPSA) serum level >20 ng/mL. The 2-year DMFS was adversely influenced by T stage, and GS >7. Multivariate analyses show that T stage is an independent factor for BFFS (p=.040), and FFS (p=.050), and that GS is an independent factor for DMFS (p=.037). Among the 17 patients with biochemical failure, the interval between PSA nadir and biochemical failure correlated significantly with 2-year DMFS (≤6 months 50.0% vs. >6 months 84.6%, p=.049). The rate of acute grade 2 gastrointestinal (GI) and genitourinary (GU) toxicities was 16.8% and 14%, respectively. The rate of late grade 2 GI and GU toxicities was 12.6% and 6.3%, respectively. Three patients (2.1%) developed late grade 3 GI toxicities. The use of a rectal balloon significantly reduced≥grade 3 late GI toxicity (without balloon it was 7.14% vs. with, 0 %, p=.046). Conclusion: Patients with prostatic adenocarcinoma undergoing definitive IMRT had T stage, initial PSA, and GS as significant prognostic factors for BFFS and FFS. T stage, GS, and the interval between PSA nadir and biochemical failure were prognostic factors for DMFS.