【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。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.[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.更多还原