超声引导^125I粒子植入治疗前列腺癌方法的建立与近期疗效

目的探讨超声引导放射性^125I粒子治疗前列腺癌方法建立和近期疗效。方法26例前列腺癌全身或硬膜外麻醉下行经直肠超声引导粒子植入治疗。经直肠超声获取前列腺图像，将图像直接传输到计算机治疗计划系统，术中适时计算机计划，肿瘤周边匹配剂量（matched peripheral doses，MPD）145～160Gy。根据治疗计划插植粒子针，利用Mick植入器植入粒子，粒子植入总数为19—90颗，粒子活度0．35～0．4mCi。术后1个月行盆腔CT扫描，质量验证。结果26例患者成功实施会阴超声和模板引导放射性^125I粒子组织间近距离治疗前列腺癌手术。手术历时1—1．5h。术后验MPD为（137．73±36．5014）Gy。26例前列腺癌患者^125I粒子治疗后生物化学控制率92．3％，2例患者术后6个月出现骨转移。^125I粒子植入治疗，34．6％无尿道副反应，Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ级尿道副反应分别为38．5％、11．5％、11．5％、0和0。Ⅰ级直肠副反应发生率为3．9％。1例患者1颗粒子移位，没有引起临床相关并发症，无粒子移位到肺。结论经会阴超声引导放射性粒子治疗前列腺癌具有微创、精确度高和副反应发生率低等优势。

Establishment and short-term efficacy of ultrasound-guided ^125I seed interstitial brachytherapy for prostatic carcinoma

Objective To investigate the establishment and short-term efficacy of uhrasound-guided ^125I seed interstitial brachytherapy for prostatic carcinoma. Methods Twenty-six patients underwent general anesthesia or extradural anesthesia. The patients were placed in the lithotomy position and a transrectal ultra- sound （TRUS） probe was used to obtain transverse images of the prostate, which were recorded at 0. 5cm spacing from the apex to the base of the prostate. Real-time treatment planning computer programs were used to customize dose distribution and the seeds were implanted with Mick applicator. The evaluation of post-implant quality was done with CT based dosimetry method 1 month after implantation. The number of seeds implanted ranged from 19 to 90. The matched peripheral doses（HPD） of ^125I were 145-160 Gy. The ^125I source activity ranged from 0. 35 to 0. 40 mCi. Results Twenty-six patients with prostate cancer underwent transperineal ultrasound-guided ^125I prostate braehytherapy successfully. The duration of seed implantation ranged from 1 to 1.5 hours. The MPD of ^125I seed implanted was 137. 73 ± 36. 5014 Gy. The biochemieals control rate was 92. 3%. The incidences of grade Ⅰ, Ⅱ ,Ⅲ, Ⅳ and V urinary side effect were 38.5%, 11.5%, 11.5%, 0 and 0 respectively. 3.12% of the patients had Grade- I rectal toxicity. 3.9% of the patients had one seed displacement. Conclusion Transperineal ^125I seed interstitial brachytherapy for carcinoma of the prostate under ultrasound guidance has advantages of minidamage, safety, high accuracy and low side effect.