经直肠穿刺^125Ⅰ粒子植入联合内分泌治疗局部晚期前列腺癌的临床疗效

Combination of transrectal ^(125)Ⅰ seeds implantation brachytherapy and intermittent hormonal therapy for locally advanced prostate cancer

目的:探讨经直肠穿刺125Ⅰ粒子植入近距离放疗联合内分泌治疗局部晚期前列腺癌的临床疗效。方法:27例局部晚期前列腺癌患者采用经直肠超声引导下经直肠穿刺125Ⅰ粒子植入联合内分泌治疗,动态监测PSA、前列腺体积、最大尿流率、国际前列腺症状评分变化。结果:所有患者植入过程顺利,实际粒子植入时间20～35 min,植入粒子40～58粒。植入后6个月,27例患者PSA<0.2μg/L,其中19例<0.1μg/L;前列腺体积与植入前相比明显缩小[(36.38±6.20)ml vs(25.81±3.77)ml,P<0.05]、最大尿流率及国际前列腺症状评分较植入前明显改善[(8.43±2.97)m/s、(19.56±2.03)分vs(16.87±1.67)ml/s、(13.45±2.17)分,P<0.05]。随访至植入后3年,19例患者处于第一周期间歇期,8例患者处于第三周期治疗期,其中2例患者病情进展,转变为雄激素非依赖性前列腺癌,2例病情恶化发生早期骨转移。3年生化无进展生存率为70.4%(19/27)、临床无进展生存率85.2%(23/27)、治疗有效率92.6%(25/27)。27例患者没有严重并发症发生。结论:经直肠穿刺125Ⅰ粒子植入联合内分泌治疗局部晚期前列腺癌安全、微创,有效延缓疾病进程,无严重尿道、直肠、勃起功能障碍等并发症。

Objective ： To evaluate the clinical efficacy of transrectal ^125I seeds implantation brachytherapy （BT） combined with intermittent hormonal therapy （IHT） in the treatment of locally advanced prostate cancer. Methods ： We treated 27 patients with lo- cally advanced prostate cancer by transreetal ^125I seeds implantation BT combined with IHT, and dynamically observed the changes in the PSA level, prostate volume, maximum urinary flow rate （Qmax） and International Prostate Symptoms Score （IPSS）. Results： All the implantation procedures were completed smoothly, lasting 20 to 35 minutes, with 40 to 58 seeds implanted. At 6 months afterimplantation, the PSA level was 〈0.2 μg/L in all the patients （ 〈0.1 μg/L in 19 cases）, the prostate volume was significantly re- duced （P 〈0.05）, and Qmax and IPSS remarkably improved （P 〈0.05）. At 3 years after implantation, 19 cases were in the first cy- cle and the other 8 in the third cycle of IHT, of which 2 progressed to androgen-independent prostate cancer, and another 2 developed early bone metastasis. The rates of 3-year biochemicaUy and clinically progression-free survival were 70.3% and 85.2%, respectively, and the rate of therapeutic effectiveness was 92.6%. No severe complications occurred in any of the cases. Conclusion ： Transrectal ^125I seeds implantation BT combined with IHT is a safe and minimally invasive procedure for locally advanced prostate cancer, which can effectively retard its chnical progression with no such complications as severe urethral, rectal or erectile dysfunction.