近距离放疗联合比卡鲁胺150mg在前列腺癌治疗中的应用

Application of brachytherapy combined with bicalutamide 150 mg monotherapy for the treatment of prostate cancer

目的探讨近距离放疗联合比卡鲁胺150mg单药治疗前列腺癌的可行性。方法将符合入选标准的71例前列腺癌患者按随机数字表分为单药组（34例）和联合药物组（37例）。接受近距离放疗后，单药组采用比卡鲁胺150mg单药内分泌治疗；联合药物组接受戈舍瑞林3．6mg＋比卡鲁胺50mg内分泌治疗。分别观察治疗前后的前列腺特异抗原（PSA）变化情况，第一阶段用药时间，严密记录治疗过程中的不良事件，并进行安全性评价。结果单药组有2例、联合药物组有1例在治疗1年后血清PSA不能下降到术前的50％予以剔除。2组患者在接受近距离放疗联合药物治疗1个月后，PSA值均出现了“断崖式”的下降。在随后的治疗中，联合药物组和单药组不良反应发生率差异无统计学意义[（41．7％（15／36）比31．3％（10／32），P=0．37]。PSA抑制率二者差异有统计学意义[（96±24）％比（98±24）％，P〈0．01），但对于低危患者，二者差异无统计学意义[（98±24）％比（100±25）％，P〉0．05）。联合药物组用药时间短于单药组[（8．1±2．0）个月比（9．5±2．5）个月，P〈0．01]，但对于低危患者，二者之间差异无统计学意义（P〉0．05）。结论前列腺癌的近距离放疗联合戈舍瑞林3．6mg＋比卡鲁胺50mg双药内分泌治疗效果较好，而对于低危患者，采用比卡鲁胺150mg单药联合近距离放疗的方案，亦能达到同样效果。

Objective To assess the feasibility of brachytherapy combined with bicalntamide 150 mg mono- therapy for the treatment of prostate cancer. Methods All 71 patients who met the inclusion criteria participated in a randomized controlled study. 68 patients with prostate cancer were randomly divided into two groups after brachy- therapy. 32 cases were treated with bicalntamide 150 mg monotherapy; other 36 patients received goserelin 3.6 mg combined with bicalutamide 50 mg. Prostate specific antigen （PSA） changes were observed before and after treat- ment and during the first stage of treatment; adverse events were recorded and security was evaluated. Chi-square test and t-test were used for statistical analysis. Results Demographic characteristics and baseline data of the 2 groups of patients were similar. After one month of brachytherapy combined with drug treatment, PSA values showed a ＂cliff-style＂ decline; during the subsequent treatment, the incidence of side effects was similiar （41.7% vs 31.3%, P =0.37） while PSA changes showed statistically significant difference [ （96 ~24）% vs （98 ±24）%, P = 0. 009 ], but for low-risk patients, there was no difference [ （98 ± 24） % vs （ 100 ± 25） %, P 〉 0.05 ]. Con- clusion For prostate cancer patients, brachytherapy combined with hormonal therapy, goserelin 3.6 mg ＋ bicalu- tamide 50 mg are recommended for low-risk cases; brachytherapy with bicalutamide 150 mg monotherapy can also a- chieve the same effect.