去势联合^125Ⅰ粒子近距离放疗治疗中晚期前列腺癌

A combination of castration with ^125Ⅰ brachtherapy in middle and late period prostate cancer.

目的探讨去势联合^125Ⅰ粒子近距离放疗治疗中晚期前列腺癌的临床疗效。方法回顾性分析2004-2009年经病理证实的66例中晚期前列腺癌患者资料。年龄61～85岁，平均72岁。其中C期40例，D期26例；G2 42例，G3 24例。采用约物去势联合抗雄激素药物的全雄性激素阻断治疗，3个月后行于术去势及近距离放疗，通过三维治疗计划系统，在经A肠超声引导下将^125Ⅰ放射性粒子均匀植入前列腺内。比较治疗前后血PSA水平、前列腺体积及IPSS评分变化情况。结果66例手术均顺利完成。每例植入粒子35～87枚，平均55枚。术后随访10～62个月，平均49个月。忠者术前血PSA（67．5±11．1）ng／ml，前列腺体积（51．4±10．0）ml，IPSS评分0．8±2．3；术后6个月PSA（1．50±0．50）ng／ml，前列腺体秋（18．7±10．7）ml，IPSS评分5．1±3．5，予术前后差异有统计学息义（P〈0．05）。结论去势联合^125Ⅰ粒子近距离放疗是综合治疗中晚期前列腺癌的有效手段。

Objective To investigate the therapeutic efficacy of castration with ^125Ⅰ brachtherapy in middle and late stage prostate cancer. Methods Sixty-six patients with prostate cancer from 2004 to 2009 were analyzed, 40 were at clinical stage C and 26 were at clinical stage D, 42 had a pathologic grade G1 and 24 had a pathologic grade G2. The first endocrinal therapy used was total androgen blockade （chemical castration and anti-androgen drugs）. The therapeutic time was three months before bilateral orchidectomy and brachtherapy. A 3D radiotherapy planning system was used for brachthera- py with transrectal uhrasound-guided radioactive ^125Ⅰ seed uniform implantation. Follow up endocrinal therapy was decided according to a monthly check of serum PSA （prostate specific antigen） levels. AI ter six months, serum PSA, IPSS and volume of the prostate before and after treatment were corn pared. Results The operations were completed successfully in all cases. The mean number of ^125Ⅰ seeds implanted was 55. The mean follow-up was 10 to 62 months, with an average of 49 months. Serum PSA, IPSS and the volume of the prostate was reduced significantly six months after operation （P〈0.05）. Conclusions Castration with ^125Ⅰ brachtherapy is an effective approach in combination therapy for treating middle and late stage prostate cancer.