高龄前列腺癌患者125I近距离放射治疗的疗效分析

Application of 125I implantation in the elderly prostate cancer patients

目的 探讨125I近距离放射治疗对高龄前列腺癌患者的近期疗效和并发症.方法 回顾性分析2007年1月至2011年12月收治的23例低危、局限性、高龄（≥75岁）前列腺癌患者的临床资料.年龄75～ 87岁,平均80岁：前列腺体积35 ～ 78 ml,平均52 ml 术前PSA 3.3～9.8 μg/L,平均（6.2±1.5）μg/L肿瘤分期：T1cN0M07例,T2aN0M016例.Gleason评分：4分5例,5分2例,6分16例.均接受单一125I近距离放射治疗,处方剂量145 Gy.观察患者的生化无复发时间、总体生存率及并发症.所有患者均未采用内分泌治疗及外放疗.结果 术后随访 4～77个月,平均50个月术后3个月血清PSA为0.9～3.8 μg/L,平均（2.4±0.4）μg/L,与术前比较差异有统计学意义（P=0.003）.术后1年血清PSA为0.2～ 2.7 μg/L,其中87％（20/23）≤1.0 μg/L2例生化复发,4年无生化复发率为91％（21/23）.死亡4例,其中仅1例死于前列腺癌脑转移,4年总体生存率为83％（19/23）,肿瘤特异生存率为96％（22/23）.尿道反应：0级34.8％ （10/23）,Ⅰ级级43.5％ （10/23）,Ⅱ级17.4％ （4/23）,Ⅲ级4.3％（1/23）,无Ⅳ、Ⅴ级病例.无前列腺直肠瘘等严重并发症发生.结论 125I近距离放射治疗对于低危、局限性、高龄前列腺癌患者安全、有效、并发症少.

Objective To evaluate the clinical safety and efficiency of applying 125I permanent-im- plant prostate brachytherapy （BRT） in elderly prostate cancer patient treatment. Methods From Jan. 2007 to Dec. 2011, 23 elderly patients （ age ≥75 years ） with a diagnosis of localized prostate cancer were treated at our institution and then were evaluated retrospectively. The average age was 79.7 （ ranged from 75- 87） years. The average prostate volume was 52 （ranged fi＇om 35-78） ml. PSA level was 6.2± 1.5 （ranged from 3.3 to 9.8） μg/L. Seven cases were in TI NoM0, sixteen cases were in T2aN0M0. Five cases were with Gleason score of 4, two cases were with Gleason score of 5, sixteen cases were with Gleason score of 6. All patients received a single 1：5I permanent-implant brachytherapy with a total dosage of 145 Gy. Patients were stratified according to biochemical recurrence-free survival （bDFS） , overall survival rate （OS） and compli- cations. All the patients had not accepted anti-androgen therapy or external radiotherapy. Results The av- erage followed up were 50 （ ranged from 4 to 77） mon （ranged from 0.9-3.8） μg/L, there was significant After 3 months, the average serum PSA was 2.4±0.4 difference compared with that before treatment （P = 0.003）. After 1 years, the average serum PSA was 0.2-2.7 μg/L and 87% （20/23） patient＇s PSA was less than 1 μg/L. 2 cases had biochemical recurrence （bNED rate, 91%）. 4 patients died, among them 1 pa- tients died of prostate cancer. The overall survival rate was 83%, and the cancer-specific survival rate was 96%. Of the patients with urethral adverse effects, 0-V adverse effect rates were 34.8%, 43.5%, 17.4%, 4.3%, 0 and 0. No serious complication such as rectal fistula occurred. Conclusions BRT is an effective and safe monotherapy in elderly prostate cancer patients.