新辅助治疗对125I粒子永久种植组织间照射治疗局部高危前列腺癌的影响

Impact of neoadjuvant hormonal therapy on the permanent 125I-seed brachytherapy for localized high-risk prostate cancer

目的 总结新辅助治疗后125I粒子永久种植组织间照射治疗局部高危前列腺癌的经验.方法 选择局部高危前列腺癌10例（T17/10;T2a3/10）;前列腺特异抗原（PSA）20～50（29.4±12.6）μg/L,前列腺体积（54±33）ml.新辅助治疗：（康士得50 mg/d 1周;康士得50 mg/d＋皮下注射诺雷德3.6 mg/4周）3～10个月（中位时间6个月）;模板法125I粒子永久种植前列腺组织间照射,前列腺组织间照射剂量145 Gy（125I粒子35～78粒,中位数46粒）,尿道周围剂量≤80 Gy,直肠周围剂量≤60 Gy,手术时间1～2.5 h,平均1.75 h.结果 新辅助治疗3～10个月后,PSA降为（1.4±0.7）μg/L;前列腺体积为（25±10）ml;与治疗前比较差异有统计学意义（P＜0.01）.125I粒子永久种植组织间照射术后3～5 d拔除尿管,1例出现排尿不畅,1例出现尿道刺激征,对症治疗后缓解.随访3～24个月（中位时间13个月）,PSA为（0.9±0.7）μg/L.结论 新辅助治疗可以降低PSA、缩小前列腺体积,从而保证靶区处方剂量,减少放疗相关并发症,提高了局部高危前列腺癌的疗效.

Objective To evaluate the impact of neoadjuvant hormonal therapy on the permanent transperineal 125I-seed brachytherapy for localized high-risk prostate cancer. Methods Ten patients with T1-T2, localized high-risk prostate cancer were reviewed. The mean level of PSA was （29. 4 ± 12. 6） μg/L （20-50 μg/L） and the mean prostate volume （54 ± 33 ） ml. All cases were sequentially treated on a neoadjuvant hormonal therapy with 1 week of Casodex （50 mg/d） and 3 -10 months（ median： 6 months）of Casodex （50 mg/d） with Zoladex （3.6 mg per 4 weeks, SC）. Then all patients received the transperineal permanent interstitial 125I-seed implantation brachytherapy by template method. The matched peripheral dose of seed implantation was 145 Gy （median number of 125I seeds： 46）, urethral peripheral dose ≤80 Gy and rectal peripheral dose ≤ 60 Gy. The mean operative duration was 1. 75 hours （range： 1 -2. 5 hours ）.Results After neoadjuvant hormonal therapy for 3 - 10 months, the PSA level decreased to （ 1. 4 ± 0. 7 ）g/L in all patients. The mean prostate volume significantly decreased to （25 ± 10） ml（t-test, P ＜0. 01 ）.The Foley tube extracted at Days 3-5 post-brachytherapy. Side effects of mild dysuria （n = 1 ） and urethral irritation （ n = 1 ） were effectively managed by symptomatic treatment. After a median follow-up of 13 months （range： 3 -24）, the PSA level was （0.9 ±0.7） μg/L. Conclusion A combination of neoadjuvant hormonal therapy with brachytherapy may lower the PSA level and shrink the prostate volume so as to ensure an effective dose in the target tumor and improve the therapeutic efficacy for localized high-risk prostate cancer.