低剂量率^(125)I近距离放疗治疗中年男性局限性前列腺癌的疗效及风险因素研究

Low dose rate ^(125)I brachytherapy for localized prostate cancer in middle-aged men

目的:研究低剂量率^(125)I近距离放疗治疗中年男性局限性前列腺癌患者的疗效及风险因素。方法:选择106例局限性前列腺癌的中年男性患者为研究对象,采用低剂量率^(125)I近距离放疗治疗。术后进行前列腺特异性抗原(PSA)及影像学监测,对粒子分布情况和剂量进行评估,并评估其不良事情、局部复发情况和PSA反弹情况,同时分析局部复发和PSA反弹的相关危险因素。结果:本研究患者术前PSA为(14.39±5.11) ng/mL,术后PSA最低值为(1.02±0.84) ng/mL,达PSA最低值平均时间为13.9个月,前列腺D90为(160±38.3) Gy,前列腺V100为(94.3±9.2) cc,移植体积为(33.7±15.1) cc。本研究患者的中位随访时间为66个月,5年局部无复发生存率、无病生存率和总生存率分别为95.28%、94.33%和92.45%。总体不良反应发生率为19.81%,以尿路刺激症状发生率(11.32%)最高。单因素分析结果显示,活检阳性率至少为50%、中度危险、新辅助激素治疗、移植前V100、无反弹发生是局部复发的危险因素,在随访期间未达到PSA<0.5 ng/mL的激素原发性患者也有较高的局部复发风险。多变量Cox分析结果显示,"至少50%活检阳性"(HR=1.02,95%CI:1.01~1.03,P=0.02)和"反弹"(HR=11.59,95%CI:1.46~91.73,P=0.02)这两个变量显著影响局部复发。35例(33.02%)患者出现PSA反弹,多变量Cox分析结果显示,较年轻的患者(HR=0.99,95%CI:0.85~0.98,P=0.01)和接受较低的治疗活度(HR=0.04,95%CI:0~0.74,P=0.03)的患者出现反弹的概率较高。结论:对中年男性局限性前列腺癌患者来说,低剂量率^(125)I近距离放疗是一种有效的低危原发性治疗方案,在中危局限性前列腺癌中也应予以考虑。

Objective: To study the efficacy and risk factors of low dose rate ^(125)I brachytherapy for localized prostate cancer in middle-aged men. Methods: One hundred and six middle-aged male patients with localized prostate cancer were selected as the study subjects and treated with low dose rate ^(125)I brachytherapy. After the operation, prostate specific antigen(PSA) and imaging monitoring were carried out to evaluate the particle distribution and dose, as well as the adverse events, local recurrence and PSA rebound. Meanwhile, the risk factors of local recurrence and PSA bounce were analyzed. Results: In this study, the PSA was(14.39±5.11) ng/mL before operation. The lowest PSA was(1.02±0.84) ng/mL after operation, and the average time to reach the lowest PSA was 13.9 months. The prostate D90 was(160.0±38.3) Gy, and the prostate V100 was(94.3±9.2) cc. The transplantation volume was(33.7±15.1) cc. The median follow-up time was 66 months. The 5-year local recurrence free survival rate, disease-free survival rate and total survival rate were 95.28%, 94.33% and 92.45%, respectively. The overall incidence of adverse reactions was 19.81%, with the highest incidence of urinary tract irritation(11.32%). Univariate analysis showed that the positive rate of biopsy was at least 50%, and moderate risk, neoadjuvant hormone therapy, V100 before transplantation and PSA bounce were the risk factors of local recurrence. The patients who did not reach PSA value <0.5 ng/mL during the follow-up period also had a higher risk of local recurrence. Multivariate Cox analysis showed that "at least 50% biopsy positive"(HR=1.02, 95%CI: 1.01-1.03, P=0.02) and " PSA bounce "(HR=11.59, 95%CI: 1.46-91.73, P=0.02) significantly affected local recurrence. Younger patients(HR=0.99, 95%CI: 0.85-0.98, P=0.01) and those treated with a lower activity per volume(HR=0.04, 95%CI: 0-0.74, P=0.03) had a higher chance of developing a bounce in the Cox model. Conclusion: For middle-aged male patients with localized prostate cancer, low dose rate ^(125)I brachytherapy is an effective and low-risk primary treatment plan, which should also be considered in the medium-risk limited prostate cancer.