放射性^125I粒子植入联合内分泌治疗早期前列腺癌

目的：探讨经会阴超声引导放射性^125I粒子植入联合去势治疗早期前列腺癌疗效和不良反应。方法：39例早期前列腺癌实施经会阴超声引导和适时计划指导放射性^125I粒子植入治疗，7例粒子术前行去势术，21例粒子植入后同时行去势术，11例粒子治疗后联合药物去势治疗。粒子治疗的匹配周边剂量（matched peripheral doses，MPD）为145—160Gy，尿道剂量低于400Gy。^125I粒子活度0．35—0．50mCi，中位植入69颗（19—97颗）。结果：失败标准为前列腺特异抗原（prostate specific antigen，PSA）治疗后升高〉4ng／ml，≤〈4ng／ml为生物化学无进展生存（biochemical disease—free survival，BDFS）。全部患者顺利完成粒子植入术。36例粒子治疗后达到BDFS，3例分别在粒子治疗后6、8和36个月PSA升高，2例行内分泌治疗，1例行外放疗联合内分泌治疗。2年和3年BDFS分别为94．8％（37／39）和92．3％（36／39）。粒子植入治疗后Ⅰ级和Ⅱ级直肠不良反应发生率分别为5．1％（2／39）和7．7％（3／39），没有Ⅲ级和Ⅳ级直肠反应。粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道不良反应发生率分别为53．8％（20／39）、17．9％（7／39）和2．6％（1／39），对症处理好转。2例粒子移位，没有相关并发症。结论：经会阴超声引导放射性^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。

Transperineal ultrasound guided ^125I seed implantation combined with endocrinotherapy for stage T1 -T2 prostate cancer

Objective：To investigate the optimal technological protocol and to observe the efficacy and morbidity of transperineal ^125I seed implantation guided by ultrasound in prostate cancer. Methods： Thirty nine patients treated with transperineal ^125I seed brachytherapy guided by transrectal ultrasound and real time TPS. The MPD of seed implantation was 140 - 160Gy. The activity of each seed was 0.35 -0.50mCi. The median number of seeds was 69 （ 19 -97）. Analysis was done after 1 month by pelvic CT scan. Biochemical failure was defined as elevations and ≥ 4ng/ml of PSA level after it reached nadir. Results：All 39 patients received ^125I seed implantation under ultrasound guidance succesefully ,36 patients achieved biochemical diseasefree survival（BDFS） ,the PSA increased for 3 patients after seed implant on 6,8 and 36 month. The BDFS of 2 years and 3 years was 94.8% and 92.3% respectively. One patient received external beam radiation therapy,3 patients received hormone therapy. The rectum side effect of grade I and 1I was 5.1% and 7.7% respectively,the urinary complications of grade Ⅰ, Ⅱ and Ⅲ were 53.8% , 17.9% and 2.6% respectively. The seed immigrant happened in 2 patients. Most of these symptoms were mild to moderate in severity and can be effectively managed by appropriate medication. Conclusion：Interstitial permanent brachytherapy with real time TPS is safe, convenient, minimally invasive,low urinary and rectal side effect.