间歇性内分泌治疗联合125Ⅰ粒子植入治疗中高危前列腺癌的临床研究

摘要

Objective To compare the clinical efficacy of intermittent hormonal therapy and intermittent hormonal therapy combine with 125Ⅰseed implantation in the treatment of intermediate and high risk prostate cancer. Methods A retrospective analysis was carried out in eighty-two patients with intermediate and high risk prostate cancer (clinical stage T2b-3aN0M0) from December 2006 to December 2012. Patients were divided into IHT group (42 cases who received intermittent hormonal therapy) and IHT+125Ⅰgroup (40 cases who received intermittent hormonal therapy combine with 125Ⅰ seed implantation brachytherapy ). Patients in IHT group were administrated with maximum androgen blockade intervention. 125Ⅰseeds were implanted into prostate in the period of the third month at first cycle of IHT, whose prescription dose was 145Gy. The levels of PSA, PV, Qmax and IPSS in pre-treatment and post-treatment were measured respectively. Results The follow-up time was 35~50 months, median was 42 months. Compared with that of pre-treatment, significant decrease in PSA and PV, and increase in Qmax and IPSS were observed at 6 months, 12 months and 24 months post-treatment between the two groups(P<0.001). There was no significant difference in the on-treatment period of the first cycle in IHT between two groups (P>0.05), but significance in off-treatment period of the first cycle(P<0.001).The biochemical progression-free survival time and 2-year biochemical progression-free survival rate(P<0.001) in the IHT+125Ⅰgroup were superior to that of IHT group (P<0.001). Patients whose post-treatment nadir PSA≤0.1ng/ml accounted for 80%(32/40) and 28.6%(12/42) in IHT+125Ⅰgroup and IHT group respectively (P<0.001). IHT+125Ⅰgroup is superior to IHT group. Conclusion IHT and IHT+125Ⅰfor prostate cancer are all effective, but IHT+125Ⅰis superior to IHT in the off-treatment period in the first cycle of IHT , biochemical progression-free survival time and 2-year biochemical progression-free survival rate, as well as post-treatment nadir PSA≤0.1ng/ml.%目的：比较间歇性内分泌治疗和间歇性内分泌治疗联合125Ⅰ粒子植入治疗中高危前列腺癌的临床疗效。方法回顾性分析2006年12月至2012年12月的中高危前列腺癌患者82例（T2b-3aN0M0）。按治疗方式分间歇性内分泌治疗组（IHT组）42例，间歇性内分泌治疗联合125Ⅰ粒子植入组（IHT+125Ⅰ组）40例。IHT均采用最大限度雄激素阻断治疗方案。125Ⅰ粒子植入在IHT第1周期的第3个月进行。采集治疗前、后的前列腺特异性抗原（PSA）、前列腺体积（prostate volume, PV）、最大尿流率（Qmax）、国际前列腺症状评分（IPSS）等指标。结果随访时间35~50月，中位随访时间42个月。与治疗前相比，两组治疗后6、12、24个月PSA控制良好，PV缩小， Qmax提高，IPSS改善，差异具有统计学意义（P 均＜0.001）。两组IHT第一周期治疗期持续时间无显著差异（P ＞0.05），间歇期持续时间差异有统计学意义（P＜0.001）。IHT+125Ⅰ组的生化无进展生存时间及2年生化无进展生存率均优于IHT组（P均＜0.001）。IHT+125Ⅰ组治疗后PSA最低值≤0.1ng/ml的病例数占该组的80%（32/40），IHT组则为28.6%（12/42），IHT+125Ⅰ组优于IHT组，两组比较差异具统计学意义（P＜0.001）。结论 IHT和IHT+125Ⅰ治疗中高危前列腺癌均有效。相对IHT，IHT+125Ⅰ能够延长IHT的第一周期间歇期持续时间及生化无进展生存时间，提高2年生化无进展生存率，且在治疗后PSA最低值≤0.1ng/ml的病例数方面具有优势。