前列腺癌患者粒子植入治疗后血清PSA变化的观察

目的探讨前列腺癌患者粒子植入治疗后血清PSA变化规律.方法前列腺癌患者13例.临床分期：T1cN0M08例,T2aN0M05例;Gleason评分：5分4例,6分9例;血清PSA 2.8～14.6 ng/ml,平均8.2 ng/ml.采用125I粒子植入治疗,治疗剂量D90为140～155 Gy.术后定期复查血清PSA,观察其变化规律.结果13例患者随访3～23个月.术后1、2、3、6、9、12、15、18及21个月血清PSA中位值为6.7、5.0、2.7、1.6、1.2、0.9、0.8、0.8及0.7 ng/ml.分别为术前血清PSA中位数的72%、51%、29%、20%、13%、11%、9%、9%及8%.术后1个月30%患者血清PSA有波动.结论前列腺癌粒子植入治疗后患者血清PSA下降缓慢,早期有波动.术后1年尤其术后3个月内血清PSA下降相对较快.     

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。     

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.     

局限性前列腺癌近距离照射治疗的有效性研究

目的 研究近距离照射治疗局限性前列腺癌的效果及其影响因素.方法 回顾性分析2001年4月至2011年3月于北京大学第一医院泌尿外科接受近距离照射治疗的61例局限性前列腺癌患者资料,其中联合外放疗11例.患者年龄57～84岁,平均75.2岁.肿瘤临床分期:T1c 12例,T2a 18例,T2b 17例,T2c 14例.Gleason评分平均7分(范围5～9分).随访术后前列腺特异抗原(PSA)变化及不良反应发生情况,绘制Kaplan-Meier生化无复发生存曲线,并以单因素Cox回归分析和Log-rank检验分析治疗效果的影响因素.结果 61例患者获得随访,随访时间9～126个月,中位随访时间49个月.术前PSA平均为(17.80±14.44) μg/L,术后PSA最低值平均为(1.16±1.15) μg/L.58例(95.1％)患者最低PSA＜4.0μg/L,37例(60.7％)患者最低PSA＜1.0μg/L,达最低PSA时间平均为术后11.6个月,术后短期不良反应少见(发热、血尿、便血等),长期不良反应主要为尿路刺激症状.近距离照射治疗后平均生化无复发生存时间的估计值为41.0个月.接受联合外放疗的11例患者治疗后PSA最低值平均为1.32 μg/L,平均生化无复发生存时间为38个月.PSA所达最低值是否＜1.0μg/L对生化无复发生存时间有显著影响(x2=4.445,P=0.035).结论 近距离照射治疗对局限性前列腺癌疗效肯定,严重不良反应少见;治疗后PSA最低值是否＜1.0μg/L有助于判断预后.     

Quality of life outcomes after brachytherapy for early stage prostate cancer

PURPOSE: We compare general and disease specific health related quality of life in men undergoing brachytherapy for early stage prostate cancer to those undergoing radical prostatectomy and age matched healthy controls. MATERIALS AND METHODS: Cohorts consisted of 48 men treated with brachytherapy with and without pretreatment external beam radiation therapy (brachytherapy group), 74 who underwent radical prostatectomy (prostatectomy group) and age matched healthy controls from the literature. The RAND 36-item general health survey, University of California Los Angeles Prostate Cancer Index, American Urological Association symptom index, validated Cancer Interference with Life and Family Scales, and sociodemographic and co-morbidity questionnaires were completed 3 to 17 months after treatment. RESULTS: General health related quality of life did not differ greatly among the 3 groups. Urinary function (leakage) was worse in the brachytherapy group than in controls but better than in the prostatectomy group. Brachytherapy group patients had more irritative urinary symptoms and worse bowel function than controls. Sexual function and bother were worse in prostatectomy and brachytherapy groups than in healthy controls. Physical function, bodily pain, urinary function, and bother and American Urological Association symptom index scores improved with time after brachytherapy. Patients who underwent brachytherapy after external beam radiation performed worse in all general and disease specific health related quality of life domains compared to those who did not undergo pretreatment radiation therapy. CONCLUSIONS: At an average of 7.5 months after treatment the general health related quality of life of patients undergoing brachytherapy with and without pretreatment external beam radiation was similar to age matched controls, although urinary, bowel and sexual problems were reported. These problems appeared to improve during the first year after treatment. Much of the impairment in disease specific health related quality of life among patients undergoing brachytherapy may be attributed to pretreatment radiation.     

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.     

125I 放射性粒子植入术联合间歇性内分泌疗法治疗局部中高危前列腺癌

目的 探讨¹²⁵I放射性粒子植入术联合间歇性内分泌疗法治疗局部中高危前列腺癌的临床价值。方法 前列腺癌患者25例,年龄 64～85 岁,平均年龄75岁,前列腺特异性抗原（PSA）：10.3～354.8 ng/mL,Gleason 评分：7～9 分,临床分期T2～T3N0M0。椎管内麻醉,截石位,直肠超声从前列腺基底到尖部进行扫描,图像传送至计算机计划系统进行三维重建和术中计划,根据计划行直肠超声引导下经会阴¹²⁵I放射性粒子植入术,术后联合全部雄激素阻断疗法。当PSA达到0 ng/mL,并稳定2个月后停止内分泌治疗,当PSA连续3次上升,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85～110粒,平均93粒。术后随访8～20个月,平均12个月。术后3～6个月所有患者的PSA都降到正常范围,其中10例患者PSA未达到0 ng/mL,未停药。5例患者术后5～16个月,出现PSA反弹,再次用药3～5个月PSA值达到0 ng/mL。2例患者转变为激素非依赖性并出现骨转移。目前17例患者的PSA值在0～1.2 ng/mL之间,其中10患者PSA< 0.2 ng/mL。近期出现的并发症有轻至中度尿路刺激征24%（6/25）,急性尿潴留8%（2/25）,直肠刺激征和血便16%（4/25）,多数患者症状随访1年后缓解。结论 对于局部晚期中高危前列腺癌,¹²⁵I放射粒子植入术联合间歇性内分泌疗法是一种安全有效的治疗方法。     

Quality of life 2 years after salvage cryosurgery for the treatment of local recurrence of prostate cancer after radiotherapy

PURPOSE: Previous research has raised concerns that although salvage cryosurgery may be an effective treatment to prevent the progression of prostate cancer after radiotherapy failure, the quality of life cost many be so severe as to prevent its acceptance as a viable treatment. The present study's purpose was to further the understanding of the quality of life outcomes of salvage cryosurgery. MATERIALS AND METHODS: A total of 46 men with locally recurrent prostate cancer after radiotherapy were recruited to participate in a prospective Phase II clinical trial using salvage cryosurgery. There were 2 questionnaires (i.e., the European Organization of Research and Treatment of Cancer QLQ C30 and the Prostate Cancer Index) administered before cryosurgery, and at 1.5, 3, 6, 12, 18, and 24 months after treatment. RESULTS: Quality of life returned to preoperative levels by 24 months after cryosurgery in all domains, with the exception of urinary and sexual functioning. At 24 months, 29% of men reported urinary bother as a moderate-to-big problem, and 56% reported sexual bother as a moderate-to-big problem. CONCLUSIONS: To our knowledge, this is the first study to evaluate prospectively men's quality of life for 2 years after salvage cryosurgery for locally recurrent prostate cancer after radiotherapy. Long-term impairments in quality of life appear to be limited to the sexual and urinary function domains. Overall quality of life appears to be high. These results support salvage cryosurgery as a viable treatment option.     

预防性造口对腹腔镜直肠癌低位前切除术后短期生活质量的影响

目的:探讨预防性造口对腹腔镜直肠癌低位前切除术后患者短期生活质量的影响。方法:采用回顾性病例对照研究方法,纳入2015年5月—2016年5月空军军医大学附属唐都医院胃肠外科病例信息完整行低位前切除术的低位直肠癌患者98例,其中48例低位前切除术后行预防性回肠造口(造口组),50例未行预防性回肠造口(未造口组),比较两组患者的临床病理资料、术后低位前切除综合征评分和生活质量评分。结果:造口组接受新辅助放化疗的与病理分期较晚的患者明显多于未造口组(均P0.05);两组吻合口漏发生率、术中出血量、淋巴结清扫数目及术后住院时间差异无统计学意义(均P0.05);无论是否接受新辅助放化疗,造口组造口还纳后1年内低位前切除综合征评分明显低于未造口组术后1年内低位前切除综合征评分(P0.05);生活质量方面,造口组总体健康状况、躯体功能及情绪功能评分在术后3个月与6个月、社会功能和角色功能评分在术后3个月、腹泻状况评分在术后半年内均明显优于未造口组(均P0.05)。结论:预防性造口可减轻腹腔镜低位直肠癌前切除术患者术后低位前切除综合征症状的严重程度,并改善术后短期生活质量。     

近距离照射联合内分泌治疗寡转移前列腺癌的临床观察

目的 探讨近距离照射联合内分泌治疗寡转移前列腺癌患者的临床疗效.方法回顾性分析2014年8月至2016年12月间本院收治的78例寡转移前列腺癌患者的临床资料,按治疗方法不同将人组患者分为对照组(42例)和研究组(36例),分别行单纯内分泌治疗和近距离照射联合内分泌治疗.观察指标为总生存率、肿瘤特异性生存率、影像学无进展...     

Patient satisfaction and quality of life after MammoSite breast brachytherapy

PURPOSE: To perform a satisfaction/quality-of-life (QOL) survey of patients undergoing MammoSite brachytherapy (MBT; Hologic, Inc, Marlborough, MA). METHODS: We asked patients 15 questions regarding treatment decision-making, and experience on-therapy/post-treatment. RESULTS: A total of 52 patients responded (median follow-up 30 months). Regarding decision-making, 5.8% viewed the avoidance of mastectomy as "not important." If MBT were not available, 55.8% would opt for whole-breast radiotherapy (WBRT) without difficulty, 28.8% would have significant travel/financial difficulty, and 15.4% would refuse radiotherapy/opt for mastectomy. Regarding choice factors, patients selected "focused therapy" (44.2%), "convenience" (36.5%), and "cutting edge" (17.3%). A total of 61.5% patients were not concerned about a second surgical procedure; 90.4% were not/somewhat concerned about infection. During treatment, 73.1% reported no pain/discomfort with catheter, 73.1% no wound difficulty, 51.0% no pain during removal, and 71.2% no pain post-treatment. A total of 98.1% of patients rated the experience good/excellent, 90.4% reported no/minor side effects, 92.3% rated cosmesis good/excellent, 98.1% were very/extremely likely to choose MBT again, and 100% would recommend MBT. CONCLUSIONS: QOL is high during/after MBT. More data are needed from ongoing trials to compare with WBRT.     

单纯125I放射性粒子植入治疗早期前列腺癌的临床分析

目的 探讨单纯125I放射性粒子植入治疗早期前列腺癌的临床疗效. 方法 2007年1月至2011年7月前列腺癌患者18例,年龄60 ～ 81岁,平均74岁.术前PSA 0.38 ～ 8.73 μg/L,平均5.09 μg/L.均经前列腺穿刺病理诊断为前列腺癌,Gleason评分5～6分,临床分期T1c～T2a.采用直肠B超引导下经会阴植入125I粒子治疗. 结果 本组手术顺利,手术时间37～52 min,平均植入粒子54粒,术后住院时间3～4d.随访时间3～57个月,平均15个月,1例失访.随访17例血PSA无进展生存率为100％ (17/17),7例随访超过18个月,血PSA水平长期低于0.20 μg/L,其中3例波动于0 ～0.08 μg/L,3例波动于0.02 ～0.12 μg/L,1例波动于0.12 ～ 0.20 μg/L.17例均未出现严重并发症. 结论 单纯125I放射性粒子植入治疗早期前列腺癌安全、有效.     

125Ⅰ放射粒子植入治疗激素难治性前列腺癌

目的　探讨12 5I放射粒子植入治疗激素难治性前列腺癌的临床价值。　方法　直肠B超引导下 ,经会阴穿刺前列腺12 5I放射粒子植入治疗激素难治性前列腺癌 15例 ,其中 5例合并骨转移者同时行转移灶外放疗。　结果　 15例手术顺利 ,平均植入12 5I放射粒子 5 6粒 ,平均手术时间 70min ,平均住院时间 5d。术后随访 5～ 2 8个月 ,平均 11个月 ,完全反应 5例 ,部分反应 4例 ,病情稳定 3例 ,病情恶化 3例 ,PSA无进展生存率 80 % ( 12 /15 ) ,未发生严重并发症。　结论　12 5I放射粒子植入治疗激素难治性前列腺癌安全、微创、并发症发生率低 ,疗效肯定。     

前列腺癌根治术后是否立即辅助内分泌治疗的META分析

目的 通过Meta分析对前列腺癌根治术后是否立即辅助内分泌治疗进行综合比较.方法 通过Pubmed、EMbase、Science Direct等数据库检索1990年至2013年相关文献.Jadad质量记分法评价纳入研究的质量,治疗组为前列腺癌术后立即给予内分泌治疗,对照组为前列腺癌术后延迟给予或不给予内分泌治疗,Meta分析评价两组总体生存率、肿瘤特异性生存率和无进展生存率.结果 5项研究入选,共4964例患者,分为治疗组2088例,对照组2876例.治疗组与对照组比较,总体生存率无统计学差异(P=0.71),肿瘤特异性生存率(P＜0.0001)和无进展生存率(P＜0.0001)有统计学差异.结论 前列腺癌根治术后立即辅助内分泌治疗可以显著提高病人的肿瘤特异性生存率和无进展生存率,但不能提高总体生存率.     

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.     

内分泌治疗晚期前列腺癌的临床研究

目的 评估睾丸切除或药物去势(醋酸戈舍瑞林)联合比卡鲁胺与单纯睾丸切除治疗晚期前列腺癌的疗效及安全性.方法 筛选2003年1月至2012年10月80例晚期前列腺癌病人进行随访评估.其中睾丸切除联合比卡鲁胺治疗的35例为A组;药物去势(醋酸戈舍瑞林)联合比卡鲁胺25例为B组,单纯睾丸切除治疗的20例为C组.80例患者随访时间3 ～118个月,平均52个月.随访内容包括治疗后药物的副反应、全身情况、肝肾功能、扩散性疼痛、PSA水平、癌肿大小以及骨转移范围、2年生存率.评价上述指标在三组间的差异.结果 随访期间,80例患者在药物的副反应、全身情况、肝肾功能、扩散性疼痛、PSA水平、癌肿大小以及骨转移范围等方面都得到观察研究,上述各研究内容在A组与B组间没有显著性差异、A组及B组与C组间有显著性差异,而三组的2年生存率分别为92％、93％、91％,没有显著性差异.结论 标准内分泌治疗晚期前列腺癌是安全的,在病变的消退和稳定、扩散性疼痛的缓解、PSA水平的恢复和骨转移范围缩小等方面较单纯睾丸切除有较好的效果.     

Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radiotherapy - preliminary results

Study Type – Prognostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? There have been no reports on the application of HDR‐BT in Japan as salvage therapy for recurrence following radiotherapy. Our data showed that salvage HDR‐BT is effective as an option for treatment of local prostate cancer recurrence after radiotherapy. OBJECTIVE

• ? To assess the preliminary clinical results of salvage high‐dose‐rate brachytherapy (HDR‐BT) applied in cases of suspected local recurrence or of residual tumour after radiotherapy.

PATIENTS AND METHODS

• ? The subjects were 11 patients who met the above conditions and underwent salvage HDR‐BT between December 2006 and January 2009. The T stage at the initial treatment was T1c in three patients, T2 in three patients and T3 in five patients.
• ? Ten patients received HDR‐BT ± electron beam radiation therapy and one patient received proton beam irradiation.
• ? Follow‐up after the completion of salvage HDR‐BT lasted 18–41 months (mean 29 months). A dose of 11.0 Gy radiation was delivered twice (22.0 Gy in total), separated by a 6‐h interval, on the day the applicators were inserted.

RESULTS

• ? Seven of the 11 cases remained in a biochemical non‐evidence of disease state.
• ? The prostate‐specific antigen (PSA) level continuously rose after salvage HDR‐BT in three of the four other cases. Hormone administration was initiated in the four cases of PSA recurrence.
• ? No G3 or more severe events occurred, and the incidence of G2 was low during this study period.

CONCLUSION

• ? Of the 11 cases treated with salvage HDR‐BT, PSA levels remained low in seven cases and the incidence of complications was also low. This suggests that salvage HDR‐BT is effective as an option for treatment of local prostate cancer recurrence after radiotherapy.

     

新辅助治疗对局部进展期直肠癌患者的生活质量的影响

目的：探讨新辅助治疗对局部进展期中低位直肠癌患者的术前、术后的生活质量的影响。 方法：将132例局部进展期的中低位直肠癌患者中47例接受术前新辅助治疗者作为观察组,另85例未行新辅助治疗者作为对照组,用欧洲癌症研究与治疗组织（EORTC）的生活质量核心量表QLQ-C30和QLQ-CR29评分来比较两组的生活质量。 结果：术前观察组的整体生活质量和情绪功能评分明显低于对照组,疲乏、恶心呕吐、食欲丧失、腹泻、经济困难以及脱发、口干、味觉异常和焦虑症状评分均高于对照组,但脓血便症状评分低于对照组（均P<0.05）。术后6个月,两组间的整体生活质量评分差异无统计学意义（P=0.167）,但是观察组的疼痛、腹泻以及排气、排便失禁和皮肤灼痛症状评分明显高于对照组（均P<0.05）,而且腹泻的评分差异一直持续到术后12个月（P=0.023）。从术前至术后12个月,观察组的阳痿和性交困难症状评分均高于对照组明显,相应的男性性功能评分也一直低于对照组（均P<0.05）,而女性患者的性功能评分只在术前低于对照组（P=0.017）。 结论：对局部进展期的中低位直肠癌,新辅助治疗会影响患者的生活质量,并以胃肠道和性功能的影响尤为明显。