^(125)I 粒子植入联合间歇性内分泌治疗局部中高危前列腺癌的临床分析

^(125)I particle implantation and intermittent endocrinotherapy in the treatment of prostate cancer of moderately high risk

目的:探讨125I粒子前列腺植入联合间歇内分泌治疗对局部中高危前列腺癌的临床疗效。方法:回顾性分析了2007年1月至2014年1月收治的前列腺癌患者36例的临床资料。年龄60~83岁,平均75.7岁。PSA:11.15-343.2ng/mL,TNM分期为T2b-T3aN0M0。Gleason评分7~10分。在连续硬膜外麻醉下,直肠超声扫描前列腺,图像传送至计算机计划系统,根据计划行经会阴125I粒子植入术,术后结合全雄激素阻断,将PSA降至0.2ng/mL以下并稳定,3个月后开始停药观察,当PSA升至大于4ng/mL再继续内分泌治疗。结果:36例患者植入粒子49~97粒,平均71粒。术后随访12~84个月,平均45个月。全部患者术后3~6个月PSA降至4ng/mL以下,1例术后12个月出现骨转移。3例于术后12~42个月死于心脑血管疾病。术后6~12个月35例患者均降至0.2ng/mL以下。除7例患者未达到停药标准,28例患者停药观察6~60个月,20例患者未见生化复发,间歇期维持时间平均27.6个月。8例于停药观察12~38个月出现PSA升高至4ng/mL以上,继续内分泌治疗。其中5例治疗3~6个月后PSA降至0.2ng/mL以下,维持6个月后再次停药观察6~15个月,4例未见生化复发,1例于停药13个月后PSA进行性升高,再次内分泌治疗无效,术后42个月后死于骨转移。8例中的另3例仍在治疗中。术后近期并发症包括尿路刺激征32例(88.89%)、急性尿潴留6例(16.67%)、直肠刺激征3例(8.33%)、血便2例(5.56%)。经对症治疗后于术后6~12个月逐渐缓解.结论:对于局部中高危前列腺,125I粒子植入术联合间歇内分泌治疗是一种安全有效的治疗方法。

Objectives： To analyze the clinical efficacy of125 ^I particle implantation with intermittent endocrinotherapy in the treatment of prostate cancer of moderately high risk. Methods： A total of 38 prostate cancer patients ranging from 60 to 83 years old（ average ages of 75. 7） were recruited. The PSA lever of these patients was 11. 15- 343.2ng / m L,and the Gleasons Score was 7- 10. All patients were clinical staged as T2b- T3aN0M0. Under continual epidural anesthesia,these patients underwent trans- rectal ultrasound. Pictures were transmitted to the computer system to make plan. According to the plan,patient received125 ^I particle implantation under the guidance of the trans- rectal ultrasound. All cases began maximal androgen blockage（ MAB） therapy after surgery. Treatment was stopped when PSA fell to 0. 2ng / m L and kept stabilized for 3 months. The criterion for the resumption of hormonal therapy was 4ng / m L. Results： All 36 cases were implanted 49- 97 particles. The follow- up period was 12- 84 months,with average of 45 months. Within the 3- 6 months after surgery,all the PSA level fell below the normal level. One case was diagnosed with bone metastasis in 12 months after surgery. 3 cases died of non- tumor recurrence and metastasis in 12- 42 months after surgery. Within the 6- 12 months after surgery,the PSA level of 35 cases fell below 0. 2ng / m L. 7 cases did not reach0. 2ng / m L,so they continued the MAB. MAB of 28 cases was stopped and followed uped for 6- 60 months. There were20 cases that did not have increased PSA level,and the average off- treatment period was 27. 6 months. 8 cases had increased PSA level in 12- 38 months after hormonal treatment was stopped,so MAB was restarted. After that,the PSA level of 5 cases fell below the 0. 2ng / m L within 3- 6 months and stabilized for 6 months. Treatment was stopped and followed up for 6- 15 months. 4 cases did not have increased PSA level. One case died of bone metastasis 42 months after post- operation. 3 cases in the 8 cases were still treated with MAB. Early complication included urethral irritation（ 88. 89%）,acute urine retention（ 16. 67%） and rectal irritation（ 8. 33%） or bloody stool（ 5. 56%）. Conclusions：The combination of125 ^I particle implantation with intermittent endocrinotherapy is an effective and safe treatment method for prostate cancer patients of moderately high risks.