^(125)I近距离治疗联合雄激素剥夺疗法治疗中-高危局限性前列腺癌的长期疗效  

Long-term efficacy of ^(125)I brachytherapy combined with androgen deprivation therapy for intermediate to high-risk localized prostate cancer

作　　者：王栋[1] 江卫星 肖泽均[1] 李长岭[1] WANG Dong;JIANG Weixing;XIAO Zejun;LI Changling(National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心北京协和医学院中国医学科学院肿瘤医院泌尿外科,北京100021

出　　处：《现代泌尿生殖肿瘤杂志》2019年第1期28-32,共5页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：国家科技重大专项(2017ZX09304015)

摘　　要：目的探讨^(125)I近距离治疗联合雄激素剥夺疗法治疗中-高危局限性前列腺癌的长期疗效及安全性。方法回顾性分析^(125)I近距离治疗联合雄激素剥夺疗法治疗的36例局限性中-高危前列腺癌患者的临床及随访资料。患者中位年龄65岁,均经前列腺穿刺活检病理证实为前列腺腺癌,Gleason评分7～8分。临床分期:T2a期9例,T2b期17例,T2c期10例。血清PSA 5.8～26.2ng/ml,中位PSA为12.8ng/ml。根据前列腺癌危险度分级,均为局限性前列腺癌,其中中危组20例、高危组16例。^(125)I放射性粒子处方剂量均为145Gy。雄激素剥夺疗法采取LHRH药物去势联合比卡鲁胺抗雄治疗,中危组行辅助治疗6个月,高危组辅助治疗12个月。全部患者术后随访60～72个月,中位随访时间为60个月。结果患者治疗6个月后PSA均降至0.2ng/ml以下,PSA最低值0.003ng/ml,中位PSA 0.01ng/ml。中危组中出现生化复发2例,恢复内分泌治疗有效,未出现临床复发。高危组中出现前列腺局部复发1例,行挽救性前列腺癌根治术后PSA降至0.003ng/ml;出现生化复发1例,恢复内分泌治疗有效。随访过程中无患者死亡。5年总生存率为100%;中危组的肿瘤无进展生存率为90.0%,高危组为87.5%,两者差异无统计学意义(P=0.816)。近距离治疗不良反应:尿路症状Ⅰ级22%(8/36)、尿路症状Ⅱ级6%(2/36)、直肠症状Ⅰ级8%(5/36),以上不良反应均于1年内消失。内分泌治疗不良反应:性欲减退100%(36/36)、勃起功能障碍100%(36/36)、潮热50%(18/36)、乏力33%(12/36)、乳房肿痛25%(9/36)、恶心14%(5/36)、贫血5%(2/36)、抑郁3%(1/36),停药后均消失。结论 ^(125)I近距离治疗联合雄激素剥夺疗法治疗中-高危局限性前列腺癌是一种安全有效的治疗方法。中危组辅助内分泌治疗6个月与高危组辅助内分泌治疗12个月的肿瘤学预后相近。Objective To explore the long-term efficacy and safety of 125 I brachytherapy combined with androgen deprivation therapy (ADT) for the treatment of intermediate to high-risk localized prostate cancer. MethodsThirty-six cases of localized prostate cancer treated with 125 I brachytherapy combined with ADT were retrospectively analyzed. The median age of the patients was 65 years. The pathological diagnosis of prostate biopsy was confirmed as adenocarcinoma, and the Gleason score was 7-8. Clinical staging showed: 9 cases in T 2a , 17 cases in T 2b , and 10 cases in T 2c stage. Serum PSA value ranged from 5.8 ng/ml to 26.2 ng/ml with a median of 12.8 ng/ml. According to the risk classification of prostate cancer, 20 cases were in the intermediat-risk group and 16 cases in the high-risk group. The prescription dose of 125 I radioactive particles was 145 Gy, and combined androgen blockade using LHRH agonist and bicalutamide were performed. The inter-mediate-risk group received adjuvant therapy for 6 months and the high-risk group for 12 months. All patients were followed up for 60-72 months, with a median period of 60 months. ResultsPSA value of these patients decreased to below 0.2 ng/ml, and the lowest value was 0.003 ng/ml with the median of 0.01 ng/ml in 6 months. Two cases of biochemical recurrence occurred in the intermediate-risk group and 1 case in the high-risk group, and effective endocrine therapy was administered again. Local recurrence occurred in 1 case in the high-risk group, and the PSA decreased to 0.003 ng/ml after salvage radical prostatectomy being performed. No patient died during follow-up. The 5-year overall survival rate is 100%, and the 5-year tumor progression-free survival rate was 90.0% in the intermediate-risk group and 87.5% in the high-risk group. There was no significant difference between the two groups ( P =0.816). Adjacent treatment adverse reactions: urinary tract symptoms: grade Ⅰ 22%(8/36), grade Ⅱ 6%(2/36);rectal symptoms: grade Ⅰ 8%(5/36). All the above adverse reactions di

关 键 词：125I 近距离治疗 局限性前列腺癌 雄激素剥夺疗法 

分 类 号：R737.25[医药卫生—肿瘤]