中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
48期
3418-3420
,共3页
庄红雨%许学敏%彭涛%林春平
莊紅雨%許學敏%彭濤%林春平
장홍우%허학민%팽도%림춘평
前列腺肿瘤%肿瘤辅助疗法%125I粒子%组织间照射治疗
前列腺腫瘤%腫瘤輔助療法%125I粒子%組織間照射治療
전렬선종류%종류보조요법%125I입자%조직간조사치료
Prostate neoplasms%Neoadjuvant therapy%125I-seed%Brachytherapy
目的 总结新辅助治疗后125I粒子永久种植组织间照射治疗局部高危前列腺癌的经验.方法 选择局部高危前列腺癌10例(T17/10;T2a3/10);前列腺特异抗原(PSA)20～50(29.4±12.6)μg/L,前列腺体积(54±33)ml.新辅助治疗:(康士得50 mg/d 1周;康士得50 mg/d+皮下注射诺雷德3.6 mg/4周)3～10个月(中位时间6个月);模板法125I粒子永久种植前列腺组织间照射,前列腺组织间照射剂量145 Gy(125I粒子35～78粒,中位数46粒),尿道周围剂量≤80 Gy,直肠周围剂量≤60 Gy,手术时间1～2.5 h,平均1.75 h.结果 新辅助治疗3～10个月后,PSA降为(1.4±0.7)μg/L;前列腺体积为(25±10)ml;与治疗前比较差异有统计学意义(P＜0.01).125I粒子永久种植组织间照射术后3～5 d拔除尿管,1例出现排尿不畅,1例出现尿道刺激征,对症治疗后缓解.随访3～24个月(中位时间13个月),PSA为(0.9±0.7)μg/L.结论 新辅助治疗可以降低PSA、缩小前列腺体积,从而保证靶区处方剂量,减少放疗相关并发症,提高了局部高危前列腺癌的疗效.
目的 總結新輔助治療後125I粒子永久種植組織間照射治療跼部高危前列腺癌的經驗.方法 選擇跼部高危前列腺癌10例(T17/10;T2a3/10);前列腺特異抗原(PSA)20～50(29.4±12.6)μg/L,前列腺體積(54±33)ml.新輔助治療:(康士得50 mg/d 1週;康士得50 mg/d+皮下註射諾雷德3.6 mg/4週)3～10箇月(中位時間6箇月);模闆法125I粒子永久種植前列腺組織間照射,前列腺組織間照射劑量145 Gy(125I粒子35～78粒,中位數46粒),尿道週圍劑量≤80 Gy,直腸週圍劑量≤60 Gy,手術時間1～2.5 h,平均1.75 h.結果 新輔助治療3～10箇月後,PSA降為(1.4±0.7)μg/L;前列腺體積為(25±10)ml;與治療前比較差異有統計學意義(P＜0.01).125I粒子永久種植組織間照射術後3～5 d拔除尿管,1例齣現排尿不暢,1例齣現尿道刺激徵,對癥治療後緩解.隨訪3～24箇月(中位時間13箇月),PSA為(0.9±0.7)μg/L.結論 新輔助治療可以降低PSA、縮小前列腺體積,從而保證靶區處方劑量,減少放療相關併髮癥,提高瞭跼部高危前列腺癌的療效.
목적 총결신보조치료후125I입자영구충식조직간조사치료국부고위전렬선암적경험.방법 선택국부고위전렬선암10례(T17/10;T2a3/10);전렬선특이항원(PSA)20～50(29.4±12.6)μg/L,전렬선체적(54±33)ml.신보조치료:(강사득50 mg/d 1주;강사득50 mg/d+피하주사낙뢰덕3.6 mg/4주)3～10개월(중위시간6개월);모판법125I입자영구충식전렬선조직간조사,전렬선조직간조사제량145 Gy(125I입자35～78립,중위수46립),뇨도주위제량≤80 Gy,직장주위제량≤60 Gy,수술시간1～2.5 h,평균1.75 h.결과 신보조치료3～10개월후,PSA강위(1.4±0.7)μg/L;전렬선체적위(25±10)ml;여치료전비교차이유통계학의의(P＜0.01).125I입자영구충식조직간조사술후3～5 d발제뇨관,1례출현배뇨불창,1례출현뇨도자격정,대증치료후완해.수방3～24개월(중위시간13개월),PSA위(0.9±0.7)μg/L.결론 신보조치료가이강저PSA、축소전렬선체적,종이보증파구처방제량,감소방료상관병발증,제고료국부고위전렬선암적료효.
Objective To evaluate the impact of neoadjuvant hormonal therapy on the permanent transperineal 125I-seed brachytherapy for localized high-risk prostate cancer. Methods Ten patients with T1-T2, localized high-risk prostate cancer were reviewed. The mean level of PSA was (29. 4 ± 12. 6) μg/L (20-50 μg/L) and the mean prostate volume (54 ± 33 ) ml. All cases were sequentially treated on a neoadjuvant hormonal therapy with 1 week of Casodex (50 mg/d) and 3 -10 months( median: 6 months)of Casodex (50 mg/d) with Zoladex (3.6 mg per 4 weeks, SC). Then all patients received the transperineal permanent interstitial 125I-seed implantation brachytherapy by template method. The matched peripheral dose of seed implantation was 145 Gy (median number of 125I seeds: 46), urethral peripheral dose ≤80 Gy and rectal peripheral dose ≤ 60 Gy. The mean operative duration was 1. 75 hours (range: 1 -2. 5 hours ).Results After neoadjuvant hormonal therapy for 3 - 10 months, the PSA level decreased to ( 1. 4 ± 0. 7 )g/L in all patients. The mean prostate volume significantly decreased to (25 ± 10) ml(t-test, P ＜0. 01 ).The Foley tube extracted at Days 3-5 post-brachytherapy. Side effects of mild dysuria (n = 1 ) and urethral irritation ( n = 1 ) were effectively managed by symptomatic treatment. After a median follow-up of 13 months (range: 3 -24), the PSA level was (0.9 ±0.7) μg/L. Conclusion A combination of neoadjuvant hormonal therapy with brachytherapy may lower the PSA level and shrink the prostate volume so as to ensure an effective dose in the target tumor and improve the therapeutic efficacy for localized high-risk prostate cancer.
