3例前列腺癌放射性125I粒子植入术的护理

对3例前列腺癌病人.行放射性^125I粒子植入术，该手术具有操作简便，危险性低．创伤小的优势，治疗效果与手术相当，而加强围手术期护理是预防术后并发症，促进康复的保证。     

^125I粒子植入术联合手术去势治疗局部晚期前列腺癌40例报告

目的：探讨^125I粒子植入术联合手术去势治疗局部晚期前列腺癌的临床效果。方法：采用直肠B超引导下经会阴植入^125I粒子并同时行双侧睾丸切除术治疗晚期前列腺癌患者40例,年龄52～87岁,平均73岁;Gleason评分为3～9分,PSA检测为0．24～2736．46ng／ml,临床分期为T3N0M0。结果：所有患者手术过程顺利,平均植入粒子71±15粒。术后随访10～76个月,中位随访时间44．5个月。远期手术并发症（〉1年）尿失禁发生率为2．5％（1／40）,轻度血便发生率为10％（4／40）,尿道直肠瘘发生率为2．5％（1／40）。1例在术后69个月死亡,有5例在术后平均15．8个月出现PSA生化复发,累计PSA无进展患者生存率为86．9％。结论：运用^125I粒子植入术联合手术去势术治疗局部晚期前列腺癌患者长期并发症少,临床效果良好。     

125Ⅰ 粒子置入治疗前列腺癌患者的护理

对22例前列腺癌患者B超引导下行前列腺125Ⅰ 粒子置入术,术前做好患者心理、生理及仪器、125Ⅰ 粒子准备,术后防止感染、保持尿道通畅;做好饮食护理及并发症观察.结果22例患者均一次顺利完成125Ⅰ 粒子置入;随访10～30个月,尿道刺激症状改善,无严重并发症发生.提示正确、合理的护理是保证B超导向下125Ⅰ 粒子组织间置入术疗效的重要环节.     

前列腺癌125I放射粒子植入术后直肠并发症及防治

目的探讨前列腺癌^125Ⅰ粒子植入术后直肠并发症及防治。方法2001年11月～2006年6月，在直肠超声引导下，经会阴前列腺^125Ⅰ放射粒子植入联合雄激素全阻断治疗中晚期前列腺癌90例，术后每1～3个月随访，观察直肠并发症及治疗。结果89例随访1～55个月，平均22个月。直肠并发症Ⅰ、Ⅱ、Ⅲ、Ⅳ级发生率分别为11．2％（10／89）、6．7％（6／89）、0％及2．2％（2／89）。Ⅰ、Ⅱ级16例观察及对症治疗，半年后症状逐渐减轻。Ⅳ级2例，1例因直肠炎在外院行多次检查和治疗，1例合并重度糖尿病，采用结肠腹壁造口，结合膀胱穿刺造瘘治疗，病情好转。结论^125Ⅰ放射粒子植入术后发生放射性直肠炎，一般采用观察及对症治疗，病情有自限性，不要盲目过度检查及治疗，对合并糖尿病者应积极治疗，以减少尿道直肠瘘的发生。     

^125Ⅰ粒子置入治疗前列腺癌患者的护理

对22例前列腺癌患者B超引导下行前列腺^125Ⅰ粒子置入术，术前做好患者心理、生理及仪器、^125Ⅰ粒子准备，术后防止感染、保持尿遗通畅；做好饮食护理及并发症观察。结果 22例患者均一次顺利完成^125Ⅰ粒子置入；随访10～30个月．尿道刺激症状改善，无严重并发症发生。提示正确、合理的护理是保证B超导向下^125Ⅰ粒子组织间置入术疗效的重要环节。     

125I放射性粒子永久植入治疗前列腺癌

目的探讨^125I放射性粒子永久植入治疗前列腺癌的疗效、适应证和并发症。方法应用Prowess2．42治疗计划系统经直肠超声引导，^125I放射性粒子植入治疗前列腺癌患者5例，临床分期T2b 4例，T3 1例。Gleason评分7分3例，6分1例，9分1例。术前PSA5．3～8．7ng／ml。结果治疗后随访12—18个月。5例患者PSA明显下降，12个月后均低于0．5ng／ml；术后3个月开始前列腺体积缩小；术后短期出现不同程度的尿路刺激症状，IPSS评分上升，尿流率下降，但3个月后逐渐好转。患者未出现血尿、血便、直肠溃疡等严重并发症。结论^126I放射性粒子永久植入适用于临床局限性前列腺癌，疗效好，并发症少，并有较好的放射安全性。     

125I放射粒子植入治疗前列腺癌12例临床分析

目的探讨前列腺125I放射粒子植入内放疗在前列腺癌治疗中的意义。方法依据治疗计划,在直肠B超引导下,经会阴穿刺植入前列腺125I放射粒子对12例前列腺癌行三维适形内放疗。结果全组手术顺利,平均植入125I放射粒子58粒,平均手术时间80min,术后平均住院时间7．2d。随访12例术后3个月结果：平均PSA由19．8ng／mL降至0．74ng／mL;随访6例术后6个月结果：5例PSA进一步降低,平均降至0．11ng／mL;1例升高,由0．51ng／mL升高至1．65ng／mL;无1例出现严重的并发症。结论采用永久性放射粒子植入前列腺、三维适形内放疗是一种有效、微创的治疗前列腺癌的方法。     

经会阴超声引导125Ⅰ粒子植入治疗前列腺癌的护理

目的 探讨经会阴超声引导125Ⅰ粒子组织间近距离植入治疗前列腺癌的护理方法及疗效.方法 对45例前列腺癌患者实施经会阴超声引导125Ⅰ粒子植入术.术前对患者进行心理护理,术中密切配合,术后进行饮食及会阴护理.结果 45例手术顺利,无1例发生粒子移位,住院3～5 d顺利出院.随访3～24个月无1例复发和转移.结论 系统的术前及术后护理是降低手术并发症,提高疗效的有力保障.     

放射性粒子125Ⅰ植入治疗肺癌并发症的护理

目的探讨CT引导下植入放射性125Ⅰ粒子治疗肺癌并发症的护理措施。方法在CT引导下,对54例中晚期肺癌患者行125Ⅰ放射性粒子植入术,术后密切观察患者并发症,对发热、咯血、气胸、放射性肺炎等并发症及时针对性处置。结果患者术后3～6个月治疗有效率达83．3％,1年生存率90．7％。术后发热21例,咯血或痰中带血11例,气胸8例,放射性肺炎5例,粒子脱落随痰排出3例,经针对性处置均好转;未出现肺栓塞等严重并发症。结论在CT引导下植入125Ⅰ放射性粒子治疗中晚期肺癌相对安全、有效,创伤小。护理人员积极科学的护理,有利于减轻患者痛苦,提高疗效。     

125I 粒子植入联合最大限度雄激素阻断治疗高危前列腺癌

目的：探讨 ¹²⁵I 放射性粒子植入联合最大限度雄激素阻断治疗高危前列腺癌的临床效果。方法：78 例高危前列腺癌患者,全身麻醉,截石位,经直肠超声勾画前列腺轮廓,计算机制定植入计划,经会阴 ¹²⁵I 放射性粒子依次植入,术后继续全雄激素阻断治疗 18 个月停止内分泌治疗,后每三月复查 PSA, PSA 连续 3 次上升≥ 2 ng/mL 或至原来底限的 2 倍,则重新开始内分泌治疗。结果：所有患者手术均顺利,植入粒子 41 ～ 94 粒,平均 69 粒。术后随访 18 ～ 54 个月,平均 35 月。术后 18 月内分泌治疗结束 56 例患者 PSA 降到 0.02 ng/mL 以下,18 例 PSA 未达到 0.02 ng/mL 以下,4 例患者出现 PSA 反弹;术后 27 月 1 例发生多发骨转移死亡;术后 39 月 3 例出现 PSA 反弹,再次全雄激素阻断内分泌治疗 3 个月 PSA 值下降到治疗时低值,目前随访中 53 例 PSA 在 0.02 ng/mL 以下,继续密切监测 PSA 及全身状况随诊观察。结论： ¹²⁵I 粒子植入联合术后全雄激素阻断内分泌治疗是治疗高危前列腺癌的一种微创、可供高危前列腺癌选择的有效方法。     

Colorectal complications of external beam radiation versus brachytherapy for prostate cancer

BACKGROUND: Although radiation therapy plays a central role in the management of prostate cancer, complications remain a troubling byproduct. We sought to determine the prevalence and significance of colorectal complications after external beam radiation (EBRT) versus brachytherapy (BT) for prostate cancer. METHODS: We performed a retrospective review of all patients undergoing EBRT or BT for prostate cancer from January 1999 to October 2005. Toxicities were graded using the Radiation Therapy Oncology Group scoring system or the modified Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer grading criteria. RESULTS: A total of 183 patients underwent EBRT and 50 patients underwent BT with a mean follow-up period of 39 months. BT was associated with significantly less acute (6% vs 43.5%) and late toxicities (2% vs 21.8%; both P < .001). Among patients receiving EBRT, acute grade 3 toxicity was experienced by 1 (.5%) patient, and grade 2 toxicity was experienced by 79 (43%) patients. Increased stool frequency was the most common manifestation (62%), followed by rectal pain and urgency (30%) and rectal bleeding (21%). Late toxicity included 34 (18.6%) patients with grade 2 toxicity (bleeding, 68%; frequent stools, 26%; pain and urgency, 18%), and 5 patients (2.7%) with grade 3 toxicity (bleeding requiring multiple cauterizations, 3; small-bowel obstruction requiring surgery, 1; anal stenosis requiring repeat dilations, 1). BT was relatively well tolerated, with only 3 patients (6%) experiencing grade 2 acute toxicity symptoms of pain and urgency. One BT patient suffered late grade 2 toxicity of bleeding requiring intervention. One patient developed rectal cancer 20 years after EBRT. CONCLUSIONS: Despite its relative safety, radiation therapy for prostate cancer has a significant incidence of colorectal complications. Overall, BT has a significantly lower incidence of acute and late toxicities than EBRT.     

The impact of prostatectomy and brachytherapy in patients with localized prostate cancer

PURPOSE: to compare urinary incontinence and erectile dysfunction symptoms reflecting quality of life and the willingness to undergo treatment again in patients treated by radical retropubic prostatectomy and low dose radiation (LDR) brachytherapy. MATERIALS AND METHODS: from July 1992 to November 2001, 158 patients with clinical localized prostate cancer were treated by radical retropubic prostatectomy with or without nerve sparring or LDR brachytherapy. To all the 158 patients we mailed a self-reporting questionnaire with 5 questions to access sexual function, 4 questions for urinary continence, and 2 for the satisfaction with the treatment and willingness to undergo treatment again. Patients had no form of adjuvant radiation therapy, or neoadjuvant or adjuvant androgen suppression therapy. A total of 56 patients (43%), 34 of the prostatectomy and 22 patients of the brachytherapy group answered the questionnaire. Questionnaire results were independently analyzed by someone else not involved with patients' treatment. RESULTS: patients self-reported some degree of erectile dysfunction in 84.8% (p = 0.01) in the group treated by prostatectomy and 23.07% (p = 0.86) in the brachytherapy group. Urinary incontinence occurred in 17.6% in the group treated by prostatectomy (p = 0.01) and in 9.5% (p = 0.52) in the brachytherapy group. Urinary incontinence and impotence significantly affected treatment satisfaction. However, considering satisfaction with the treatment and willingness to undergo treatment again, 88.2% of patients would elect surgery again and 95.5% brachytherapy again.     

Permanent interstitial brachytherapy for prostate cancer: a current review

Prostate brachytherapy with permanent radioactive implants is becoming an increasingly popular treatment choice for patients with prostate cancer. This therapy is attractive to patients due to the fact that it is an outpatient procedure and in many cases has been associated with lower long-term risks of urinary incontinence and erectile dysfunction when compared to other curative modalities. This review will describe the history, isotopes used, implantation techniques, and results achieved with modern prostate brachytherapy. Results will be discussed both in terms of cancer control and health-related quality of life endpoints.     

放射性粒子组织间植入治疗局限性前列腺癌

目的：探讨放射性粒子组织间植入治疗局限性前列腺癌的安全性和有效性。方法：采用实时直肠超声引导经会阴穿刺放射性^125I粒子组织间植入治疗T1～T2c期前列腺癌患者45例。结果：45例患者手术均顺利完成,手术时间60～120（平均90）min,植入^125I粒子数40～75（平均56）枚。术后随访12～48个月,血PSA〈1μg／L29例,血PSA为1～2μg／L 11例,血PSA≥2μg／L5例。结论：放射性粒子组织间植入治疗局限性前列腺癌安全有效。     

Association of chromosomal locus 8q24 and risk of prostate cancer: a hospital-based study of German patients treated with brachytherapy

BackgroundGenetic susceptibility contributes to the risk of prostate cancer but the underlying genes are largely unknown. Polymorphic loci on chromosome 8q24 have emerged as possible risk factors for breast and prostate cancer from genome-wide association studies.ObjectiveWe aimed to define the risks associated with two single nucleotide polymorphisms, rs1447295 and rs13281615, in a hospital-based series of prostate cancer patients treated with brachytherapy.Material and methodsWe analyzed genomic DNA samples of 488 prostate cancer cases undergoing brachytherapy at Hannover Medical School, and of 462 male controls from the same location. Genotyping was performed using 5′-exonuclease allelic discrimination assays, and results were evaluated with χ² tests and logistic regression analyses.ResultsWe investigated whether rs1447295 and rs13281615 are associated with disease risk in a hospital-based prostate cancer case-control series from Northern Germany. The rare allele of rs1447295 was observed at higher frequency among cases than among hospital-based controls (13.9% vs. 10.2%, P = 0.01), and there was a dose-dependent trend towards a higher prevalence of heterozygous and homozygous carriers among the prostate cancer patients (per allele OR 1.42, 95% CI 1.07; 1.87, P = 0.02). By contrast, the rare allele of rs13281615 did not predispose to prostate cancer (per allele OR 0.84, 95% CI 0.70; 1.00, P = 0.05). The distribution of combined 8q24 genotypes was significantly different between cases and controls (P = 0.01).ConclusionOur results corroborate previous reports of 8q24 as a prostate cancer susceptibility locus and provide evidence for rs1447295 as a potentially important genetic marker. Further studies are required to confirm whether the adjacent breast cancer-associated variant rs13281615 may be inversely associated with prostate cancer risk.     

Brachytherapy monotherapy may be sufficient for a subset of patients with unfavorable intermediate risk prostate cancer

Purpose/objective(s)

Brachytherapy (BT) monotherapy is a well-established treatment modality for favorable intermediate risk (FIR) prostate cancer. However, patients with unfavorable intermediate risk (UIR) disease are often recommended trimodality therapy involving BT, androgen deprivation therapy (ADT), and external beam radiation therapy (EBRT). We sought to investigate the relative benefit of supplemental therapies (ADT and/or EBRT) for FIR and UIR prostate cancer in a large dataset.

Transperineal image-guided permanent brachytherapy for localized cancer of the prostate

Traditionally, organ-confined adenocarcinoma of the prostate has been treated with radical prostatectomy or external beam radiotherapy (EBRT). Permanent implantation of iodine-125 (I-125) seeds into the prostate via a free-hand, retropubic approach was introduced in 1970. However, its popularity was short-lived because suboptimal results were obtained due to the inadequate and inhomogeneous distribution of seeds within the prostate gland. Over the last decade, there has been a resurgence in prostate brachytherapy due to the introduction of a transperineal approach, transrectal ultrasound imaging, fluoroscopy, three-dimensional visualization, and computerized treatment planning. Thus, the radioactive seeds can be placed more accurately and homogeneously within the prostate gland. Selection criteria for brachytherapy is based on the pretreatment prostate specific antigen level, clinical stage at presentation, and Gleason grade. Patients with high likelihood of organ-confined disease are treated with brachytherapy only, whereas those with more advanced disease are treated with brachytherapy in conjunction with EBRT and/or hormonal manipulation. I-125 (145 Gy) or palladium-103 (120 Gy) are the common radioisotopes used. Ten-year actuarial biochemical progression-free rates of 64 to 93% (which are comparable to those obtained by surgery or EBRT), with minimum associated morbidity, have been reported from centers routinely performing transperineal permanent prostate brachytherapy. Brachytherapy is a good treatment option for localized prostate cancer and the results very much depend on the expertise, skill, and experience of the brachytherapy team. Randomized clinical trials are required to firmly establish the role of brachytherapy in the management of localized prostate cancer.     

前列腺癌近距离治疗后下尿路症状变化的观察分析

目的 探讨前列腺癌近距离治疗后下尿路症状的变化发展规律,为临床治疗提供指导.方法 接受近距离治疗的前列腺癌患者122例.年龄48～84岁,平均72岁.l临床分期为,T1c NoMo～T3aNoMo.治疗前PSA 0.9～65.0 ng/ml,Gleason评分5～9分,前列腺体积12～57 ml.国际前列腺症状评分(IPSS评分)3～19分,平均12分.植入粒子30～86粒,活度11.1～19.6 MBq,总活度444 1591 MBq;植入针16～28根.术前2周至术后6个月常规使用α受体阻滞剂,术前1～6个月使用新辅助治疗106例(86.9%).观察治疗后下尿路症状的变化.结果 122例随访3～34个月,平均21个月.急性尿潴留8例(6.6%),保留尿管5～14 d后拔除均可自行排尿;轻度尿失禁10例(8.2%),均在术后2～4个月好转.出现尿频、尿急及排尿困难或加重107例(87.7%).术后0.5、1、2、3、6、9、12、15、18、21、24及30个月出现尿频、尿急及排尿困难或加重者分别为16.4%、80.3%、81.2%、74.6%、42.0%、25.2%、18.5%、11.5%、7.4%、2.5%、3.3%及0.下尿路症状持续时间与治疗前IPSS评分及前列腺体积成正相关,P值分别为0.012及0.003.结论 前列腺癌近距离治疗后下尿路症状常见,持续时间较长,但不严重,均可恢复.持续时间与治疗前IPSS评分及前列腺体积相关.使用α受体阻滞剂及新辅助治疗可以有效缓解症状并避免手术干预.