单纯内分泌与内分泌加内照射治疗晚期前列腺癌的疗效对比分析

目的：研究核素内照射改善前列腺癌骨转移引起的疼痛及对骨转移治疗的疗效，并与内分泌治疗进行比较。方法：对52例前列腺癌骨转移患者均采用双侧睾丸切除加氟他胺（250mg,3次／d)治疗。所有患者均于术前不同时间出现明显的疼痛症状，其中15例接受^89锶内照射治疗（148MBq静脉注射），8例接受^153Sm-EDT-MP内照射治疗（37MBq/kg静脉注射，1次／月）；29例未接受内照射治疗者作为对照组。结果：^89锶治疗组有14例患者疼痛明显缓解，占93．3％（14／15）；^153Sm-EDTMP治疗组有6例疼痛明显缓解，占75．0％（6／8）；单纯内分泌治疗组经调整药物剂量或结构后，疼痛明显缓解者仅9例，占31．0％（9／29）。^99Tcm-MDP全身骨显像示骨转移病灶出现不同程度的好转，其中^89锶治疗组有11例，占73．3％（11／15）；^153Sm-EDTMP治疗组有5例，占62．5％（5／8），而单纯内分泌组有7例，占24．1％（7／29）。^89锶治疗组3例、^153Sm-EDTMP治疗组有2例出现血白细胞和血小板明显下降，经对症治疗后恢复。结论：核素内照射治疗能改善前列腺癌骨转移引起的疼痛，并可不同程度地抑制肿瘤骨转移灶的生长，但必须密切观察血红蛋白、白细胞及血小板的变化。

Clinical analysis of the effect of systemic radionuclide therapy combined with the endocrine therapy for advanced prostate cancer, comparing with the only endocrine therapy

Purpose:To investigate the effect of the systemic radionuclide therapy for the pain of bone metastasis of advanced prostate cancer, comparing with the only endocrine therapy. Methods:From March 1998 to March 2001, 52 patients of advanced prostate cancer with bone metastasis accepted the treatment of bilateral orchidectomy and Flutaminde (250 mg every 8 hours) in this hospital. 15 of the 52 patients also accepted intravenously infusion of 89 Srcl 2 (148 MBq); 8 of the 52 patients accepted intravenously infusion of 153 Sm EDTMP (37MBq/kg once a month); the others accepted the only endocrine therapy.Results:14 of 15 patients who accepted 89 Srcl 2 infusion had obvious pain relief, and 6 patients in the 153 Sm EDTMP group had the same result. However, even changed the dose and type of the drugs, lessening of pain was observed in only 9 patients of the endocrine therapy group. By the way of the systemic bone screen of 99 Tcm MDP the bone metastasis lesions were controlled and recovered in 73% of the 89 Srcl 2 group, 62% of the 153 Sm EDTMP group and 24% of the only endocrine therapy group. The leukothrombopenia was observed in 3 patients of the 89 Srcl 2 group and 2 patients of the 153 Sm EDTMP group. Then all of them had recovered after the expectant treatment.Conclusions:The systemic radionuclide therapy can obviously relief the pain caused by the bone metastasis of advanced prostate cancer and inhibit the development of bone metastasis lesions effectively. But during the treatment the blood cell counts shall be followed up carefully.