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经会阴超声引导放射性125I粒子植入治疗早期前列腺癌
Transperineal ultrasound guided 125I seed implantation for early stage prostate cancer
【作者】 王俊杰; 黄毅; 冉维强; 姜伟娟; 刘江平; 田素青;
【Author】 WANG Junjie△,HUANG Yi,RAN Weiqiang,JIANG Weijuan,LIU Jiangping,TIAN Suqing (Peking University 3rd Hospital,Beijing 1 00083,China)
【机构】 北京大学附属第三医院;
【摘要】 探讨经会阴超声引导放射性125I粒子植入治疗早期前列腺癌疗效和副反应。[方法 ]39例前列腺癌实施经会阴超声引导和适时计划指导放射性125I粒子植入术。10例单纯粒子治疗的匹配周边剂量(matched peripheraldoses,MPD)为140~145Gy,尿道剂量低于400Gy。29例术后1个月加外照射,剂量45~50Gy,5次/周,2Gy/次。1251粒子活度0.35~0.60mCi,中位植入69颗(平均19~97颗)。术后行睾丸去势21例,11例联合内分泌治疗。失败标准为前列腺特异抗原(prostate specific antigen,PSA)治疗后升高>4ng/ml,≤4ng/ml为生物化学无进展生存(biochemicaldisease-free survival,BDFS)。[结果 ]39例患者顺利完成粒子植入术。36例患者粒子治疗后达到BDFS,3例患者分别在粒子治疗后25、31和36个月PSA升高,2年和3年BDFS分别为100%和73.9%。2例患者在粒子植入治疗后25个月出现全身转移,行内分泌治疗。1例粒子治疗后36个月PSA升高,行外放疗。1例PSA升高行内分泌治疗。粒子植入治疗后Ⅰ级和Ⅱ级直肠副反应发生率分别为5.1%和7.7%,没有Ⅲ级和Ⅳ级直肠反应。粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道副反应发生率分别为53.8%、17.9%和2.6%,对症处理好转。2例患者粒子移位,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。
【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.[Method]39 patients treated with transperineal 125I seed brachytherapy guided by transrectal ultrasound and real time TPS.The MPD of 10 patients was 140~160Gy and 29 patients was 110~115Gy,External beam radiotherapy was given after 1 month and the total dose was 45~50Gy.21 patients received the testectomy after seed implantation and 11 patients received hormone therapy.The activity of each seed was 0.35~0.60mCi.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]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 25,31 and 36 month.The BDFS of 2 years and 3 years was 100%and 73.9%respectively.One patient received external beam radiation therapy,2 patients received hormone therapy.The rectum side effect of gradeⅠandⅡwas 5.1%and 7.7%respectively,the urinary complications of gradeⅠ,ⅡandⅢwere 53.8%,17.9%and 2.6%respectively.The seed immigrant had happen in 2 patients.Most of these symptoms are 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.
【Key words】 125I seed; Brachytherapy; Prostate carcinoma; Ultrasound guidance; PSA;
- 【会议录名称】 中国(第七届)肿瘤微创治疗学术大会暨世界影像导引下肿瘤微创治疗学会成立筹备大会论文汇编
- 【会议名称】中国(第七届)肿瘤微创治疗学术大会暨世界影像导引下肿瘤微创治疗学会成立筹备大会
- 【会议时间】2011-09-23
- 【会议地点】中国广东广州
- 【分类号】R737.25
- 【主办单位】中国抗癌协会肿瘤微创治疗专业委员会、广东省抗癌协会肿瘤影像与介入诊治专业委员会、广州抗癌协会肿瘤微创治疗专业委员会、中山大学附属肿瘤医院