放射性^(125)I粒子植入治疗睾丸切除术后复发性前列腺癌

Transperineal ^(125)I Seed Implantation in Recurrent Prostatie Cancer After Testectomy Guided by Transrectal Ultrasonography

目的 :探讨超声引导放射性 12 5I粒子植入治疗复发前列腺癌。方法 :8例前列腺癌去势术后复发实施超声引导放射性 12 5I粒子植入治疗。 2例单纯粒子植入治疗 ,肿瘤匹配周边剂量为 (matchedpe ripheraldose ,MPD) 90～ 14 5Gy ,2例先行外放疗 ,外放疗剂量为 4 0～ 4 5Gy。粒子活度 0 35～ 0 4 0mCi。随访 3～ 2 9个月 ,连续 3次前列腺特异抗原 (prostatespecificantigen ,PSA)升高即为生物化学失败 (bio chemicalfailure)。结果 :粒子治疗前后PSA分别为 (7 5 3± 7 6 4)ng mL和 (1 2 5± 1 19)ng mL ,统计学处理明显下降 ,t=2 2 97,P =0 0 38。 2例生物化学失败 ,生物化学控制率 (biochemicalcontrolrate)为 6 8例 ,1例出现 1级泌尿道并发症 ,1例出现 2级泌尿道并发症。 1 8例患者粒子发生移位 ,但是并没有引起临床相关并发症 ,没有粒子移位到肺。结论 :超声引导经会阴放射性 12 5I粒子植入治疗复发前列腺癌具有安全、微创、并发症发生率低和疗效肯定 ,是一种较理想的补救治疗手段。

Objective To investigate the efficacy of transperineal 125 I seed implantation in recurrent prostate cancer guided by transrectal ultrasonography.Methods Eight patients with recurrent prostate cancer were treated with transperineal 125 I seed implantation guided by transrectal ultrasonography.The MPDs of 125 I monotherapy were 90-145 Gy,the doses of EBRT were 40-45 Gy.The activity of 125 I per seed ranged from 0 35 to 0 40 mCi.Follow up ranged from 3 to 29 months.Biochemical failure was defined as three consecutive rises in PSA following treatment.Results All patients well tolerated seed implantation,the median pre and post treatment serum PSA values of 8 cases with 125 I monotherapy were significantly decreasing from (7 53±7 64)ng/mL to (1 25±1 19)ng/mL, t =2 297, P =0 038.Two cases were biochemical failure,the biochemical control rate was 6/8 cases.One patient experienced Grade 1 urinary morbidity and one patient experienced Grade 2 urinary morbidity,1/8 cases had 1 seed migration, the migration of seed did not cause any clinical relative morbidity.Conclusion Transperineal 125 I seed implantation in recurrent prostate cancer guided by transrectal ultrasonography is safety,minimally invasion,low morbidity and high efficacy,and it is a favorable salvage treatment.