协和医学杂志

2011, v.2(01) 24-27

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前列腺癌近距离治疗疗效
Outcomes of Prostate Cancer Patients after Brachytherapy

严维刚;李汉忠;周毅;陈健;李宏军;张福泉;
YAN Wei-gang1,LI Han-zhong1,ZHOU Yi1,CHEN Jian1,LI Hong-jun1,ZHANG Fu-quan21Department of Urology,2Department of Radiotherapy,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的探讨前列腺癌患者近距离治疗疗效及并发症。方法前列腺癌患者27例,年龄63~81岁,平均75岁。临床分期:T1cN0M016例,T2aN0M011例;Gleason评分:5分14例,6分13例;血清前列腺特异性抗原(prostate specific antigen,PSA)2.8~14.6μg/L,平均8.5μg/L。采用125I粒子近距离治疗,治疗剂量D90为140~155Gy,观察治疗疗效及并发症。27例患者治疗前后均未使用内分泌治疗。结果 27例患者随访12~74个月,平均44个月。近距离治疗后27例前列腺癌患者最低血清PSA中位数为0.18μg/L,2例患者最低血清PSA在1.0μg/L以上;治疗后1年患者血清PSA中位数为0.71μg/L,平均为0.92μg/L,17例患者血清PSA在1.0μg/L以下;2例患者分别于治疗后30及48个月出现生化复发,复发率7%(2/27)。治疗后2例患者出现急性尿潴留,予保留导尿1周后好转;24例治疗后出现不同程度的尿路刺激症,均在治疗后6~12个月内好转;无1例出现前列腺直肠瘘。治疗前17例有勃起功能;治疗后10例仍保留不同程度的勃起功能,7例出现勃起功能障碍(占41%)。结论前列腺癌近距离治疗对于中低危前列腺癌疗效肯定,并发症少,多数患者可以保留性功能。
Objective To evaluate the effectiveness and complications of prostate brachytherapy.Methods We enrolled 27 prostate cancer patients aged 63 to 81 years(mean:75 years)in our study,with 16 at the clinical stage of T1cN0M0,11 at T2aN0M0,and 14 with Gleason score of 5,13 with Gleason score of 6.Their serum prostate specific antigen(PSA)levels ranged 2.8-18.6 μg/L(mean:8.5 μg/L).All of them underwent 125I seed implantation with the D90 of 140-155 Gy and had the serum PSA levels routinely determined after the procedure.Effectiveness and complications were also observed.None of the 27 patients were treated with hormone therapy.Results Follow-up ranged from 12 to 74 months(mean:44 months).The median nadir PSA was 0.18 μg/L,with only 2 above 1.0 μg/L.One year after brachytherapy,the median level of serum PSA was 0.71 μg/L(mean:0.92 μg/L),and 17 with the level under 1.0 μg/L.Two patients(7%)experienced biochemical failure at the 30 month and 48 month after the procedure.Two patients(7%)developed acute urinary retention,which was released after catheterization for 1 week.Low urinary tract symptoms were observed in 24 patients,which were improved 6-12 months later.No prostate-rectal fistula was observed.Seventeen patients erected efficiently before brachytherapy,while 10 preserved erection in different levels after brachytherapy.The incidence of erectile dysfunction was 41%(7/17).Conclusion Prostate brachytherapy is an effective treatment for low-and intermediate-risk patients with acceptable complications.Most patients can preserve sexual function after this procedure.

关键词(KeyWords): 前列腺癌;近距离治疗;前列腺特异性抗原
prostate carcinoma;brachytherapy;prostate specific antigen

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基金项目(Foundation): 中央保健局基金(B2009B091)

作者(Author): 严维刚;李汉忠;周毅;陈健;李宏军;张福泉;
YAN Wei-gang1,LI Han-zhong1,ZHOU Yi1,CHEN Jian1,LI Hong-jun1,ZHANG Fu-quan21Department of Urology,2Department of Radiotherapy,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China

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