125Ⅰ粒子近距离治疗前列腺癌临床应用

目的探讨经会阴超声引导放射性125Ⅰ粒子近距离治疗前列腺癌的近期疗效和并发症.方法32例前列腺癌患者实施经会阴超声引导放射性125Ⅰ粒子植入术,11例单纯粒子治疗,6例术前或术后配合外放疗.15例粒子植入术后加睾丸去势术.连续3次前列腺特异抗原(prostatespecific antigen,PSA)升高即为生物化学失败.结果14例原发前列腺癌粒子植入治疗前和治疗后血清PSA分别为(52.14±54.61)ng/ml和(4.26±7.11)ng/ml,统计学处理差异有显著性(t=3.253,P=0.003),生物化学控制率为100%.12例去势术后复发患者125Ⅰ粒子植入治疗前和治疗后PSA分别为(15.14±20.80)ng/ml和(18.94±35.25)ng/ml(t=-0.307,P=0.764),统计学处理差异无显著性,生物化学控制率为75%.5例骨转移患者术前和术后PSA分别为(120.03±145.96)ng/ml和(75.53±84.84)ng/ml(t=0.527,P=0.621),统计学处理差异无显著性.125Ⅰ粒子单纯植入治疗34.62%患者无尿道副反应,Ⅰ～Ⅴ级尿道副反应发生率分别为38.46%、11.54%、11.54%、0和3.85%.125Ⅰ粒子植入联合外放疗组Ⅰ～Ⅳ级副反应发生率分别为16.67%、0、0和16.67%.Ⅰ级直肠副反应发生率为3.12%.3.12%患者1颗粒子移位,没有引起临床相关并发症,无粒子移位到肺.结论超声引导经会阴放射性125Ⅰ粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点.     

超声引导125I粒子治疗前列腺癌引起的直肠并发症

目的探讨经会阴超声引导放射性^125I粒子近距离治疗前列腺癌的直肠并发症。方法80例前列腺癌患者实施经会阴超声引导放射性^125I粒子植入术，其中68例单纯粒子植入治疗，12例行粒子治疗联合外放疗。单纯^125I粒子治疗肿瘤匹配周边剂量（matched peripheral dose，MPD）为140～160Gy，联合组^125I粒子植入MPD为90～110Gy。联合组外照射剂量为40～50Gy/4～5周，20Gy/次，5次/周，4野照射，粒子植入后4周进行。根据术中计划，利用Mick枪后退式植入粒子，活度为0．35～0．50mCi，中位植入粒子65颗（平均19～100颗）。术后1个月行盆腔CT扫描，进行质量验证。结果68例单纯放射性^125I粒子植入治疗前列腺癌后直肠Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级副反应发生率分别为7．3％、4．4％、2．9％和1．5％，而12例^125I粒子植入治疗和联合外放疗直肠副反应Ⅰ级和Ⅱ级发生率分别为10％和10％，没有Ⅲ级以上直肠副反应。直肠反应出现中位时间12月（1～16个月）。结论超声引导经会阴放射性^125I粒子植入治疗前列腺癌直肠并发症发生率可以接受，需要进一步明确直肠剂量与发生副反应的关系。     

放射性粒子近距离治疗前列腺癌：临床篇

放射性粒子种植治疗前列腺癌是近20年发展起来的新技术，尤其是近5年，由于超声或CT引导介入，计算机三维治疗计划系统指导，使这一技术具有疗效高、创伤小、并发症发病率低等优势，临床应用发展十分迅猛。     

125I粒子近距离治疗前列腺癌临床应用

目的探讨经会阴超声引导放射性125Ⅰ粒子近距离治疗前列腺癌的近期疗效和并发症.方法32例前列腺癌患者实施经会阴超声引导放射性125Ⅰ粒子植入术,11例单纯粒子治疗,6例术前或术后配合外放疗.15例粒子植入术后加睾丸去势术.连续3次前列腺特异抗原(prostatespecific antigen,PSA)升高即为生物化学失败.结果14例原发前列腺癌粒子植入治疗前和治疗后血清PSA分别为(52.14±54.61)ng/ml和(4.26±7.11)ng/ml,统计学处理差异有显著性(t=3.253,P=0.003),生物化学控制率为100%.12例去势术后复发患者125Ⅰ粒子植入治疗前和治疗后PSA分别为(15.14±20.80)ng/ml和(18.94±35.25)ng/ml(t=-0.307,P=0.764),统计学处理差异无显著性,生物化学控制率为75%.5例骨转移患者术前和术后PSA分别为(120.03±145.96)ng/ml和(75.53±84.84)ng/ml(t=0.527,P=0.621),统计学处理差异无显著性.125Ⅰ粒子单纯植入治疗34.62%患者无尿道副反应,Ⅰ～Ⅴ级尿道副反应发生率分别为38.46%、11.54%、11.54%、0和3.85%.125Ⅰ粒子植入联合外放疗组Ⅰ～Ⅳ级副反应发生率分别为16.67%、0、0和16.67%.Ⅰ级直肠副反应发生率为3.12%.3.12%患者1颗粒子移位,没有引起临床相关并发症,无粒子移位到肺.结论超声引导经会阴放射性125Ⅰ粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点.     

放射性粒子近距离治疗前列腺癌：临床篇

放射性粒子种植治疗前列腺癌是近20年发展起来的新技术,尤其是近5年,由于超声或CT引导介入,计算机三维治疗计划系统指导,使这一技术具有疗效高、创伤小、并发症发病率低等优势,临床应用发展十分迅猛。     

125I粒子近距离照射在肿瘤治疗中的应用

125I的生物物理学特性适合近距离照射治疗,125I作为粒子源植入体内,目前在国外广泛用于各种恶性肿瘤的治疗,尤其是用于前列腺癌的治疗已相当成熟,取得了良好的疗效,但在治疗中还存在一定的问题.     

~(125)I粒子植入在肿瘤治疗中的应用

概述125I粒子组织间植入的作用原理以及适应证、禁忌证。125I粒子在治疗脑胶质瘤、肺癌、肝癌、胰腺癌、前列腺癌等临床疗效及副作用,并对放疗粒子治疗恶性肿瘤提出了需解决的问题。     

125Ⅰ粒子源近距离治疗前列腺癌模型的剂量学研究

目的 研究放射性125Ⅰ粒子源在治疗前列腺癌中的剂量分布,探寻治疗计划系统(TPS)优化效果的有效方法.方法 选定1个治疗计划系统,应用热释光剂量计,基于前列腺癌等效模体,模拟测量前列腺癌中的剂量分布.模拟植入共89颗125Ⅰ粒子,每个粒子的活度为1.37×107Bq(±5%).结果 各层的最大剂量为151～241 Gy,与处方剂量145 Gy的偏差在4.1%～66.0%.各层的最小剂量在101～128 Gy,与处方剂量的偏差在12%～30%.离模体边缘10 mm处正常组织的最大剂量为46～91 Gy,偏差为44%～63%.结论 该系统对实际的粒子植入治疗,评估TPS提供了实用的方法.

Abstract：

Objective To study the dose distribution of the radioactive 125Ⅰ seeds sources in the treatment of prostate cancer and also to explore the more effective method for improving treatment planning system (TPS).Methods Choose the designated TPS and use TLDs dosimeter based on a prostate cancer model.Finally stimulated measurement was focused on dose distribution in prostate cancer.The number of 125Ⅰ seed sources implanted was 89, each with 1.37 × 107 ( ± 5% ) Bq.Results Maximum dose of every layer ranged from 151 to 241 Gy, by 4.1% to 66.0% higher than the prescribed dose (145 Gy).The Minimum dose of every layer ranged from 101 to 128 Gy, by 12% to 30% higher than the prescribed dose.The maximum dose of normal tissue at 10 mm from the edge of model ranged from 46 to 91 Gy.The deviation was 44% -63% compared with the prescribed dose.Conclusions The designated TPS shows that it could be used as a practical guide for treatment of prostate cancer with the radioactive 125Ⅰ seed sources.The research methods offered by the study can provide evaluation of the TPS.     

125Ⅰ粒子源近距离治疗前列腺癌模型的剂量学研究

目的 研究放射性125Ⅰ粒子源在治疗前列腺癌中的剂量分布,探寻治疗计划系统(TPS)优化效果的有效方法.方法 选定1个治疗计划系统,应用热释光剂量计,基于前列腺癌等效模体,模拟测量前列腺癌中的剂量分布.模拟植入共89颗125Ⅰ粒子,每个粒子的活度为1.37×107Bq(±5%).结果 各层的最大剂量为151～241 G...     

^125I粒子近距离照射在肿瘤治疗中的应用

^125I的生物物理学特性适合近距离照射治疗，^125I作为粒子源植入体内，目前在国外广泛用于各种恶性肿瘤的治疗，尤其是用于前列腺癌的治疗已相当成熟，取得了良好的疗效，但在治疗中还存在一定的问题。     

Needle position during (125)I seed implantation: accurately recognized by sagittal transrectal ultrasonography [corrected

Purpose  The aim of this study was to assess the variation of probe rotation angles for detecting a single needle using sagittal images of transrectal ultrasonography (TRUS). Materials and methods  A phantom study was performed. One needle was inserted through each of 10 holes of the template, and variations in the probe rotation angles for detecting the needle were measured. Results  The mean variation of probe rotation for detecting a single needle was 17.0° (range 4°–25°). Slightly broader variation was seen for the needle in holes farther away from the probe. Conclusion  Probe rotation angles for detecting a single needle displayed considerable variation. Seed locations recognized on sagittal imaging by TRUS are thus indeterminate, and real-time dose calculations using TRUS for ¹²⁵I seed implantation should be used with care.     

Fluoroscopy guided transperineal percutaneous permanent 125iodine implantation of prostate cancer

The transperineal percutaneous template permanent iodine interstitial brachytherapy under "C-arm" fluoroscopic guidance is a simple, easily-learned, accurate and rapid procedure which can be performed without subjecting the patient to celiotomy. We have treated 58 patients by the transperineal percutaneous permanent interstitial brachytherapy. The use of transperineal percutaneous technique with C-arm fluoroscopic guidance improves the symmetry and dosimetry of the implant. This results in reduction of the incidence of chronic radiation-induced complications. In the group of 22 patients who underwent brachytherapy without celiotomy and lymphadenectomy and without adjuvant external-beam radiotherapy, there were no major complications.     

Evaluation of post-plan dosimetry using TRUS and CT after transperineal prostate seed implant

The purpose of this study was to evaluate the variability in dosimetry due to the change in prostate volume for permanent transperineal brachytherapy seed implant. This research is the beginning of an in-house quality assessment program. Nineteen cases were retrospectively evaluated. A single physician defined prostate volumes in all cases. Group A consisted of 3 cases that were treated with external-beam radiation therapy (EBRT) to 4500 cGy, followed by a brachytherapy implant boost of 10,800 cGy. Group B included 16 cases that were implant only, prescribed to 14,400 cGy. Prostate images were acquired before seed implant using transrectal ultrasound (TRUS), immediately following seed implant using TRUS, and by computed tomography (CT) acquired several weeks postimplant. The prostate images were digitized into a commercial treatment planning system for planning purposes and dosimetric evaluation for the 3 procedures. Prostate volumes were calculated by the treatment planning system. Additional data collected included the percentage of prostate receiving the prescribed dose and dose to 90% and 80% of the prostate. The dose delivered to V₁₅₀ was also recorded. Overall, the postimplant ultrasound plan showed similar coverage to the ultrasound preplan, while the CT postplan revealed less than expected dosimetric coverage. The postplan CT results prompted us to evaluate our scheduling process, as well as prostate definition using TRUS and CT.     

Prostate-specific antigen bounce in patients treated before 60 years old by iodine 125 brachytherapy for prostate cancer is frequent and not a prognostic factor

PurposeThe only prognostic factor of prostate-specific antigen (PSA) bounce in prostate cancer found in several studies is young age but has never been specifically studied in this subset of patients for long-term results. Bounce characteristics, histological, clinical, and dosimetric data in young patients were analyzed, as well as their impact on toxicity and survival.Material and MethodsThis retrospective study included patients aged ≤60 years treated with exclusive iodine 125 brachytherapy with low or intermediary prostate adenocarcinoma during 1999–2014. Exclusion criteria were a follow-up of ≤24 months. PSA bounce was defined as a ≥0.2-ng/mL increase above the interval PSA nadir, followed by a decrease to nadir or below.ResultsThis study analyzed 179 patients. Median age was 56 years (46–59 years). The median follow-up was 79 months (54; 123). The bounce incidence was 56.8% (49.6%; 64.2%) at 5 years, inversely proportional to positive/total biopsies ratio (HR 0.98, 95% CI [0.97, 0.99]). Incidence of biochemical failure was 1.2%, 95% CI (0.3%; 4.7%), at 5 years with no difference between the bounce and no-bounce group (HR 0.96, 95% CI [0.25; 3.58]). Bounce is an unfavorable prognostic factor for grade two and three urinary toxicities 6.67 (4.14; 10.76) (p < 0.001).ConclusionsPSA bounce is common in young people after brachytherapy. It should be monitored without starting an inadequate and sometimes invasive relapse checkup or a relapse treatment.     

CT引导~(125)I粒子治疗非小细胞肺癌的辐射防护护理干预

目的 探讨在CT引导下125I粒子植入微创治疗非小细胞肺癌(NSCLC)辐射防护护理干预的措施及注意事项.方法 对89例NSCLC患者实施有计划和验证的125I粒子植入治疗,进行围手术期的全程防护护理干预,观察分析植入治疗的成功率、疗效参数和并发症发生率.结果 科学合理的辐射防护护理干预能保障放射性粒子植入的剂量学分布符合有效和微创的原则,植入治疗成功率达到100%,局部控制有效率为96.7%,1年生存率为92.2%;早期和晚期放射反应发生率分别为14.6%和1.1%.未出现放射性泄漏污染事件.结论 包含全程放疗计划和验证的125I粒子植入疗法,结合科学的辐射防护护理干预措施,对提高NSCLC的疗效和明显降低并发症的发生具有重要的临床价值.     

Combination conformal radiotherapy and radioimmunoguided transperineal Pd implantation for patients with intermediate and unfavorable risk prostate adenocarcinoma

PURPOSE: To report outcomes for prostate cancer patients treated with external beam radiation therapy (EBRT) and permanent prostate brachytherapy utilizing radioimmunoguided targeting of biological tumor volumes (BTVs). METHODS AND MATERIALS: Between February 1997 and October 2001, 66 patients with intermediate- to high-risk prostate cancer underwent EBRT and ProstaScint-guided transperineal brachytherapy. Thirty patients received neoadjuvant hormonal manipulation, while 36 patients did not. Median patient age was 66 years (range, 49-78 years). The median follow-up was 41 months (range, 24-78 months). No patients were lost to follow-up. Risk factors (RF) used for risk stratification included PSA >10 ng/ml (35 patients), Stage T2b or greater (22 patients), and Gleason score > or = 7 (55 patients). Results for biochemical disease free survival (bDFS) were reported using the ASTRO consensus definition for biochemical failure, PSA < or = 1.0 ng/mL or PSA< or = 0.5 ng/mL. Survival was estimated by the Kaplan-Meier method. RESULTS: Five-year overall survival was 93.1% and 5-year bDFS by the ASTRO definition was 89.3% with a median follow up of 41 months. Patients with intermediate- (1 RF) and high-risk (2-3 RF) prostate cancer exhibited 5-year ASTRO-defined bDFS of 100% and 81.9%, respectively. There was no significant difference in bDFS between the patients treated with or without hormone therapy (HT). The 5-year ASTRO-defined bDFS was 89.8% for the 30 patients treated with HT and 88.9% for the 36 patients who did not receive HT (p = 0.843). For the patients without HT the median PSA nadir was 0.11 ng/mL. The median time to nadir was 23 months (range, 6-66 months). CONCLUSIONS: With limited follow-up, the results of EBRT plus radioimmunoguided brachytherapy for intermediate- to high-risk prostate cancer appear favorable. The addition of HT did not appear to affect bDFS significantly, but interpretation is confounded by possible selection bias and the limited power of this study.     

CT导向下^125I粒子组织间插植治疗恶性肿瘤的临床应用

目的：介绍CT导向下^125I粒子组织间插植治疗恶性肿瘤的技术方法并评价其临床价值。方法：17例36个恶性肿瘤病灶，在CT引导下进行肿瘤内^125I粒子组织间插植。首先根据影像资料，利用TPS计算出治疗肿瘤所需要^125I粒子的最佳数量及分布，然后在CT导向下经皮穿刺将^125I粒子植入到肿瘤内，术后2月随访。结果：CR17个（47．2％），PR11个（30．6％），NC4个（11．1％），PD1个（2．8％）。结论：CT导向下组织间植入^125I粒子治疗恶性肿瘤是一种安全、可靠、疗效显著的治疗方法。