【摘要】 目的:探讨经会阴超声引导放射性125I粒子植入联合去势治疗早期前列腺癌疗效和不良反应。方法:39例早期前列腺癌实施经会阴超声引导和适时计划指导放射性125I粒子植入治疗,7例粒子术前行去势术,21例粒子植入后同时行去势术,11例粒子治疗后联合药物去势治疗。粒子治疗的匹配周边剂量(matchedperipheraldoses,MPD)为145-160Gy,尿道剂量低于400Gy。125I粒子活度0.35-0.50mCi,中位植入69颗(19-97颗)。结果:失败标准为前列腺特异抗原(prostatespecificantigen,PSA)治疗后升高>4ng/ml,≤4ng/ml为生物化学无进展生存(biochemicaldisease-freesurvival,BDFS)。全部患者顺利完成粒子植入术。36例粒子治疗后达到BDFS,3例分别在粒子治疗后6、8和36个月PSA升高,2例行内分泌治疗,1例行外放疗联合内分泌治疗。2年和3年BDFS分别为94.8%(37/39)和92.3%(36/39)。粒子植入治疗后Ⅰ级和Ⅱ级直肠不良反应发生率分别为5.1%(2/39)和7.7%(3/39),没有Ⅲ级和Ⅳ级直肠反应。粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道不良反应发生率分别为53.8%(20/39)、17.9%(7/39)和2.6%(1/39),对症处理好转。2例粒子移位,没有相关并发症。结论:经会阴超声引导放射性125I粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点。更多还原

【Abstract】 Objective:To investigate the optimal technological protocol and to observe the efficacy and morbidity of transperineal 125I seed implantation guided by ultrasound in prostate cancer.Methods:Thirty nine patients treated with transperineal 125I seed brachytherapy guided by transrectal ultrasound and real time TPS.The MPD of seed implantation was 140-160Gy.The activity of each seed was 0.35-0.50mCi.The median number of seeds was 69(19-97).Analysis was done after 1 month by pelvic CT scan.Biochemical failure was defined as elevations and ≥4ng/ml of PSA level after it reached nadir.Results:All 39 patients received 125I seed implantation under ultrasound guidance succesefully,36 patients achieved biochemical disease-free survival(BDFS),the PSA increased for 3 patients after seed implant on 6,8 and 36 month.The BDFS of 2 years and 3 years was 94.8% and 92.3% respectively.One patient received external beam radiation therapy,3 patients received hormone therapy.The rectum side effect of grade ⅠandⅡ was 5.1% and 7.7% respectively,the urinary complications of grade Ⅰ,Ⅱ and Ⅲ were 53.8%,17.9% and 2.6% respectively.The seed immigrant happened in 2 patients.Most of these symptoms were mild to moderate in severity and can be effectively managed by appropriate medication.Conclusion:Interstitial permanent brachytherapy with real time TPS is safe,convenient,minimally invasive,low urinary and rectal side effect.更多还原