^(125)I粒子近距离治疗前列腺癌临床应用

Clinical application of transperineal ^(125)I-seed implantation guided by ultrasonography in prostate cancer

目的 探讨经会阴超声引导放射性1 2 5I粒子近距离治疗前列腺癌的近期疗效和并发症。方法 32例前列腺癌患者实施经会阴超声引导放射性1 2 5I粒子植入术 ,11例单纯粒子治疗 ,6例术前或术后配合外放疗。 15例粒子植入术后加睾丸去势术。连续 3次前列腺特异抗原 (prostatespecificantigen ,PSA)升高即为生物化学失败。结果 14例原发前列腺癌粒子植入治疗前和治疗后血清PSA分别为 (5 2 14± 5 4 6 1)ng ml和 (4 2 6± 7 11)ng ml,统计学处理差异有显著性 (t=3 2 5 3,P =0 0 0 3) ,生物化学控制率为 10 0 %。 12例去势术后复发患者1 2 5I粒子植入治疗前和治疗后PSA分别为 (15 14± 2 0 80 )ng ml和 (18 94± 35 2 5 )ng ml(t=- 0 30 7,P =0 76 4 ) ,统计学处理差异无显著性 ,生物化学控制率为 75 %。 5例骨转移患者术前和术后PSA分别为 (12 0 0 3± 14 5 96 )ng ml和(75 5 3± 84 84 )ng ml(t =0 5 2 7,P =0 6 2 1) ,统计学处理差异无显著性。1 2 5I粒子单纯植入治疗34 6 2 %患者无尿道副反应 ,Ⅰ～Ⅴ级尿道副反应发生率分别为 38 4 6 %、11 5 4 %、11 5 4 %、0和3 85 %。1 2 5I粒子植入联合外放疗组Ⅰ～Ⅳ级副反应发生率分别为 16 6 7%、0、0和 16 6 7%。Ⅰ级直肠副反应发生率为 3 12 %

Objective To establish an optimal technological protocol,and to observe the shortterm efficacy and morbidity of transperineal 125Iseed implantation guided by transrectal ulrtrasonography in prostate cancer. Method Thirtytwo patients were treated with transperineal 125Iseed brachytherapy guided by transrectal utasound.Among them 6 patientts were treated with the seed implantation plus pre or postexternal beam radiotherapy(EBRT).Biochemical failure was defined as consecutive elevations of PSA level for three times during followup period and the biochemical progressionfree was defined as biochemical control. Results The pre and postimplantation median serum PSA values of 14 patients were (52.14±54.61) ng/ml and (4.26±7.11) ng/ml,respectively (t=3^253,P=0^003).The biochemical control rate was 100%.The pre and posttreatment median PSA values of 12 recurrent prostate cancer patients were (15.14±20.80) ng/ml and (18.94±35.25) ng/ml,respectively (t=-0.307,P=0.764).Their biochemical control rate was 75%.The pre and postimplantation median PSA values of 5 patients with bone metastases were (120.03±145.96) ng/ml and (75.53±84.84) ng/ml,respectively (t=0.527,P=0.621).In 34.62% patients treated only with 125Iseed implication urinary complications were not experience and the incidences of Grade Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ urinary side effects were 38.46%,11.54%,11.54%,0 and 3.85%,respectively.The incidences of Grade Ⅰ,Ⅱ,Ⅲ and Ⅳ urinary morbidity were 16.67%,0,0 and 16.67%,respectively for patients treated with seed implantation plus EBRT. Grade 1 rectal toxicity was noted in 3^12% patients.In 3^12% patients, one seed migration occurred. Conclusion Transperineal intersitiu permanent brachytherapy is safe,convenient,minimally invasive,with low urinary and rectal side effects.;