新辅助内分泌治疗在前列腺癌^125碘近距离治疗中的应用  

Application of neoadjuvant hormonal therapy in ^125I permanent seed implantation for prostate cancer

作　　者：崔昕[1] 李强[1] 许建军[1] 李进[1] 欧彤文[1] 

机构地区：[1]首都医科大学宣武医院泌尿外科,北京100053

出　　处：《中华医学杂志》2012年第38期2710-2712,共3页National Medical Journal of China

摘　　要：目的观察新辅助内分泌治疗对前列腺癌近距离治疗患者的疗效和生活质量的影响，评价新辅助内分泌治疗在前列腺癌^125I永久粒子种植中的应用价值。方法共入组165例T1c—T3b的前列腺癌患者，患者年龄的中位数为79（65—88）岁。患者分为2组，一组90例进行新辅助内分泌治疗3个月联合超声引导下经会阴穿刺^125I永久粒子种植，另一组75例直接行粒子植入。观察患者在新辅助内分泌治疗前后血清PSA的变化，前列腺体积的变化，粒子种植前后泌尿系统、性功能方面的毒副反应变化以及PSA的变化规律。结果^125I永久粒子种植前的新辅助内分泌治疗使患者的血PSA中位数由26．50（3．56～150．0）μg／L降低到0．38（0．01—6．56）μg／L，前列腺体积中位数由46．38（19．28～128．10）ml减小到29．33（23．62—65．21）ml。粒子种植术后随访时间为24个月，术后联合治疗组和单纯粒子植入组PSA降低的最低值的中位数分别为0．62和2．56μg/L，术后急性尿潴留分别为6例和9例。结论新辅助内分泌治疗在前列腺癌^125I永久粒子种植中可起到减少粒子种植，缩小前列腺体积和降低血PSA水平，降低粒子植入并发症。新辅助内分泌治疗对患者术后复发率及生存率和性功能方面的影响尚需大样本研究。Objective To explore the therapeutic response and toxicity of neoadjuvant hormonal therapy in ^125I permanent seed implantation for prostate cancer and validate the clinical efficacy of neoadjuvant hormonal therapy. Methods A total of 165 patients with Tle-T3b prostate cancer received transperineal ultrasound-guided ^125I permanent seed implantation and neo-adjuvant hormonal therapy （NHT）. Their median age was 79 years （range： 65 -88）. They were randomized into 2 groups： group A （n = 90, 3-month NHT before ^125I permanent seed implantation for prostate cancer 0 and group B （n = 75, 1251 permanent seed implantation）. The prostate surface antigen （PSA） response rate, the change of prostate volume and the toxicities of urinary system and sexual function were observed. Results The median PSA decreased to 0. 38（0. 01 -6. 56） μg/L from 26. 50（3. 56 - 150. 00） μg/L after a 3-month neoadjuvant hormonal therapy and the median prostate volume dropped from 29. 33 （ 23. 62 - 65.21 ） ml from 46. 38 （ 19. 28 - 128. 10） ml during a follow-up period of 24 months. After brachytherapy, the PSA level was maintained at a relatively low level （median number of 0. 62 μg/L and 2. 56μg/L in groups A and B respectively）. And 6 and 9 patients suffered from acute urinary retention after brachytherapy in groups A and B respectively. Conclusion Neoadjuvant hormonal therapy can reduce the volume of prostate before brachytherapy and serum PSA in a short time. The toxicities of urinary system, gastrointestinal tract and sexual function should be examined by further randomized control studies. A long-term observation is needed for the PSA-free survival rate.

关 键 词：前列腺肿瘤 肿瘤辅助疗法 ^125I粒子 近距离治疗 

分 类 号：R737.25[医药卫生—肿瘤]