CAJ | 학술논문

目的：探讨125 I 粒子前列腺植入联合间歇内分泌治疗对局部中高危前列腺癌的临床疗效。方法：回顾性分析了2007年1月至2014年1月收治的前列腺癌患者36例的临床资料。年龄60～83岁，平均75.7岁。PSA：11.15－343.2ng／mL，TNM分期为 T2b －T3a N0 M0。Gleason 评分7～10分。在连续硬膜外麻醉下，直肠超声扫描前列腺，图像传送至计算机计划系统，根据计划行经会阴125 I 粒子植入术，术后结合全雄激素阻断，将 PSA 降至0.2ng／mL 以下并稳定，3个月后开始停药观察，当 PSA 升至大于4ng／mL 再继续内分泌治疗。结果：36例患者植入粒子49～97粒，平均71粒。术后随访12～84个月，平均45个月。全部患者术后3～6个月 PSA 降至4ng／mL 以下，1例术后12个月出现骨转移。3例于术后12～42个月死于心脑血管疾病。术后6～12个月35例患者均降至0.2ng／mL 以下。除7例患者未达到停药标准，28例患者停药观察6～60个月，20例患者未见生化复发，间歇期维持时间平均27.6个月。8例于停药观察12～38个月出现 PSA 升高至4ng／mL以上，继续内分泌治疗。其中 5例治疗3～6个月后 PSA 降至0.2ng／mL 以下，维持 6个月后再次停药观察6～15个月，4例未见生化复发，1例于停药13个月后 PSA 进行性升高，再次内分泌治疗无效，术后42个月后死于骨转移。8例中的另 3例仍在治疗中。术后近期并发症包括尿路刺激征32例（88.89％）、急性尿潴留6例（16.67％）、直肠刺激征3例（8.33％）、血便 2例（5.56％）。经对症治疗后于术后6～12个月逐渐缓解.结论：对于局部中高危前列腺，125 I 粒子植入术联合间歇内分泌治疗是一种安全有效的治疗方法。
목적：탐토125 I 입자전렬선식입연합간헐내분비치료대국부중고위전렬선암적림상료효。방법：회고성분석료2007년1월지2014년1월수치적전렬선암환자36례적림상자료。년령60～83세，평균75.7세。PSA：11.15－343.2ng／mL，TNM분기위 T2b －T3a N0 M0。Gleason 평분7～10분。재련속경막외마취하，직장초성소묘전렬선，도상전송지계산궤계화계통，근거계화행경회음125 I 입자식입술，술후결합전웅격소조단，장 PSA 강지0.2ng／mL 이하병은정，3개월후개시정약관찰，당 PSA 승지대우4ng／mL 재계속내분비치료。결과：36례환자식입입자49～97립，평균71립。술후수방12～84개월，평균45개월。전부환자술후3～6개월 PSA 강지4ng／mL 이하，1례술후12개월출현골전이。3례우술후12～42개월사우심뇌혈관질병。술후6～12개월35례환자균강지0.2ng／mL 이하。제7례환자미체도정약표준，28례환자정약관찰6～60개월，20례환자미견생화복발，간헐기유지시간평균27.6개월。8례우정약관찰12～38개월출현 PSA 승고지4ng／mL이상，계속내분비치료。기중 5례치료3～6개월후 PSA 강지0.2ng／mL 이하，유지 6개월후재차정약관찰6～15개월，4례미견생화복발，1례우정약13개월후 PSA 진행성승고，재차내분비치료무효，술후42개월후사우골전이。8례중적령 3례잉재치료중。술후근기병발증포괄뇨로자격정32례（88.89％）、급성뇨저류6례（16.67％）、직장자격정3례（8.33％）、혈편 2례（5.56％）。경대증치료후우술후6～12개월축점완해.결론：대우국부중고위전렬선，125 I 입자식입술연합간헐내분비치료시일충안전유효적치료방법。
Objectives:To analyze the clinical efficacy of 125 I particle implantation with intermittent endocrino-therapy in the treatment of prostate cancer of moderately high risk.Methods:A total of 38 prostate cancer patients ran-ging from 60 to 83 years old (average ages of 75.7)were recruited.The PSA lever of these patients was 11.15 -343. 2ng/mL,and the Gleasons Score was 7 -10.All patients were clinical staged as T2b -T3a N0 M0 .Under continual epidural anesthesia,these patients underwent trans -rectal ultrasound.Pictures were transmitted to the computer system to make plan.According to the plan,patient received 125 I particle implantation under the guidance of the trans -rectal ultra-sound.All cases began maximal androgen blockage (MAB)therapy after surgery.Treatment was stopped when PSA fell to 0.2ng/mL and kept stabilized for 3 months.The criterion for the resumption of hormonal therapy was 4ng/mL.Re-sults:All 36 cases were implanted 49 -97 particles.The follow -up period was 12 -84 months,with average of 45 months.Within the 3 -6 months after surgery,all the PSA level fell below the normal level.One case was diagnosed with bone metastasis in 12 months after surgery.3 cases died of non -tumor recurrence and metastasis in 12 -42 months after surgery.Within the 6 -12 months after surgery,the PSA level of 35 cases fell below 0.2ng/mL.7 cases did not reach 0.2ng/mL,so they continued the MAB.MAB of 28 cases was stopped and followed uped for 6 -60 months.There were 20 cases that did not have increased PSA level,and the average off -treatment period was 27.6 months.8 cases had in-creased PSA level in 12 -38 months after hormonal treatment was stopped,so MAB was restarted.After that,the PSA level of 5 cases fell below the 0.2ng/mL within 3 -6 months and stabilized for 6 months.Treatment was stopped and fol-lowed up for 6 -15 months.4 cases did not have increased PSA level.One case died of bone metastasis 42 months after post -operation.3 cases in the 8 cases were still treated with MAB.Early complication included urethral irritation (88.89%),acute urine retention (16.67%)and rectal irritation (8.33%)or bloody stool (5.56%).Conclusions:The combination of 125 I particle implantation with intermittent endocrinotherapy is an effective and safe treatment method for prostate cancer patients of moderately high risks.