前列腺癌的近距离放疗与内分泌治疗的比较

Comparison analysis of brachytherapy versus endocrine therapy for patients with prostate cancer

目的比较^125Ⅰ粒子植入近距离放疗与问歇性内分泌治疗在前列腺癌治疗中的效果。方法2001年1月至2006年2月期间，未能接受根治性前列腺切除的前列腺癌患者74例，分为2组，43例采用单纯间歇性内分泌治疗；31例单纯采用近距离^125Ⅰ粒子植入，比较2组患者的临床症状、PSA变化情况、局部进展率、无事件生存率。结果5年生存率和无事件生存率在两组之间比较差异无统计学意义。对于危险分级低危的病例，近距放疗组无事件生存率为77．78％（7／9），内分泌治疗组的无事件生存率为26．67％（4／15），两者之间存在差异（P=0．015）；治疗一年后PSA及PSA的变化两组比较，差异均无统计学意义。治疗一年后PSA比较，两组间差异存在统计学意义（P=0．003）；治疗前后的PSA的变化差异亦存在统计学意义（P=0．038）。结论对于早期、低危的前列腺癌的治疗首选近距放疗，对于晚期、中高危患者，内分泌治疗与近距放疗效果相近，是否需要联合治疗，需要进一步实践研究。

Objective To study the effects of ^125Ⅰ seed implantation brachytherapy and intermittent hormonal therapy for patients with prostate cancer. Methods From January 2001 to February 2006, a total of 74 patients with prostate cancer, who couldn＇t undergo radical prostatectomy, were divided into two groups. Forty-three of them received the intermittent endocrine therapy alone, while 31 cases received the close- ~^125Ⅰ seed implantation. Their symptoms, PSA changes, local progression rate and event-free survival in the two groups were comparatively analyzed. Results The total of 74 patients, 5-year survival rate, event-free survival was no significant difference between two groups. However, for the low-risk grade patients, the event-free survival of the brachytherapy group was 77.78% （7/9）, the event-free survival rate of endocrine treatment group was 26.67% （4/15）. There was a significant differences between the two groups （P=0.015）; By the patients of low risk classification, the serum PSA one year after treatment showed significant differences between the two groups（P=0.003）; significant difference was also found in PSA （P=0.038） before and after treatment. For the intermediate to high risk grade patients, there was not significant differences between the two groups. Conclusion For patients with early low-risk prostate cancer, brachytherapy is the first choice. For patients with advanced, intermediate-risk and high-risk prostate cancer, the endocrine therapy and brachytherapy show the same effect. Suggestions of the integral therapy needs further study.